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. 2018 Jul;102(7):1156-1164.
doi: 10.1097/TP.0000000000002178.

Solid Organ Transplantation in Patients With Preexisting Malignancies in Remission: A Propensity Score Matched Cohort Study

Sergio A Acuna  1   2   3   4   5 , Rinku Sutradhar  1   5 , S Joseph Kim  1   5   6 , Nancy N Baxter  1   2   3   4   5
Affiliations

Solid Organ Transplantation in Patients With Preexisting Malignancies in Remission: A Propensity Score Matched Cohort Study

Sergio A Acuna et al. Transplantation. 2018 Jul.

Abstract

Background: Solid-organ transplant recipients with pretransplant malignancies (PTM) have worse overall survival (OS) compared to recipients without history of malignancy. However, it is unknown whether the increased risk of mortality is due to recurrent cancer-related deaths.

Methods: All solid-organ transplant recipients in Ontario between 1991 and 2010 were identified and matched 1:2 to recipients without PTM using a propensity score. OS was compared using the Kaplan-Meier estimator and Cox proportional hazard models. For cancer-specific mortality and cancer recurrence, cause-specific hazard models were used and the cumulative incidence was plotted.

Results: Recipients with PTM had a worse OS compared with recipients without PTM (median OS, 10.3 years vs 13.4 years). Recipients with PTM were not only at increased risk of cancer-specific mortality (cause-specific hazard ratio, 1.85; 95% confidence interval [CI], 1.20-2.86) but also at increased risk of noncancer death (cause-specific hazard ratio, 1.29; 95% CI, 1.08-1.54). Compared with recipients without PTM, recipients with high-risk PTM had higher all-cause mortality (hazard ratio, 1.81; 95% CI, 1.47-2.23). Recipients with low-risk PTM were not at increased risk (hazard ratio, 1.06; 95% CI, 0.86-1.31).

Conclusions: Recipients with PTM are at increased risk of all-cause mortality compared to recipients without PTM. This increased risk was noted for both cancer-specific and noncancer mortality. However, only those with high-risk PTM had worse outcomes.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Cohort selection flow diagram.
FIGURE 2.
FIGURE 2.
OS by history of PTM.
FIGURE 3.
FIGURE 3.
OS by (A) pretransplant cancer site, (B) time between cancer diagnosis and transplantation, and (C) interaction terms of time between cancer diagnosis and pretransplant cancer site.
FIGURE 4.
FIGURE 4.
Risk of all-cause mortality by PTM cancer site. HRs for OS were generated using 2 Cox proportional hazard models: (1) by type of malignancy (low- or high-risk) compared to no pretransplant cancer (grey squares), and (2) by cancer site compared with no pretransplant cancer (black squares). Cancer sites listed under low- or high-risk malignancy correspond to each category.
FIGURE 5.
FIGURE 5.
Cumulative incidence of (A) cancer death and (B) noncancer death comparing recipients with PTM to those without prior cancer history. Cancer death by (C) pretransplant cancer site and (D) TCT. CIFs were compared using the Gray test.
FIGURE 6.
FIGURE 6.
Cancer recurrence after transplantation. Cumulative incidence of (A) cancer recurrence and (B) death without recurrence by time between cancer diagnosis and transplantation (upper panels) and type of PTM (lower panels). CIFs were compared using the Gray test.
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