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. 2023 Jul;149(7):3325-3333.
doi: 10.1007/s00432-022-04227-3. Epub 2022 Aug 6.

Pancreatic cancer among solid organ transplant recipients in the United States

Tomohiro Tanaka  1 , Charles F Lynch  2 , Kelly J Yu  3 , Bozena M Morawski  4 , Mei-Chin Hsieh  5 , Georgetta Alverson  6 , April A Austin  7 , Yun Zeng  8 , Eric A Engels  3
Affiliations

Pancreatic cancer among solid organ transplant recipients in the United States

Tomohiro Tanaka et al. J Cancer Res Clin Oncol. 2023 Jul.

Abstract

Introduction: Pancreatic cancer (PC) in solid organ transplant (SOT) recipients is not well studied. Some PC cases may be incidentally detected during hepatobiliary imaging.

Methods: We evaluated PC among 374,106 SOT recipients during 1995-2017 in the United States using linked data from the national transplant registry and multiple state/regional cancer registries. Standardized incidence ratios (SIRs) were used to compare PC risk in recipients to the general population. We used multivariate Poisson regression to identify independent risk factors for PC. We assessed survival after PC diagnosis using Kaplan-Meier curves and log-rank tests.

Results: SOT recipients had elevated incidence for PC compared with the general population (SIR 1.40, 95% CI 1.29-1.52), and this increase was strongest in liver recipients (1.65, 1.41-1.92). Among all recipients, PC incidence was especially increased for cases arising in the head of the pancreas (SIR 1.50, 95% CI 1.34-1.68) and for cases diagnosed at localized stage (1.85, 1.37-2.44). Among SOT recipients, factors independently associated with increased incidence were consistent with those in general population including male sex, older age, non-O blood type, and history of diabetes. Additionally, compared to other organ recipients, liver transplant recipients had higher PC incidence (adjusted incidence rate ratio 1.28; 95% CI 1.06-1.54). Overall survival after PC diagnosis was poor (median 4 months) and similar between liver and other organ transplant recipients (p = 0.08).

Conclusions: PC incidence is elevated among SOT recipients, and more commonly diagnosed in liver transplant recipients perhaps related to incidental detection. However, survival is poor even in liver recipients, arguing against routine PC screening.

Keywords: Cancer epidemiology; Pancreatic cancer; Solid organ transplantation.

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Conflict of interest statement

The authors declare no competing interests.

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Gastroenterology.

Figures

Fig. 1
Fig. 1
Survival after diagnosis of pancreatic cancer in solid organ transplant recipients according to stage (a) and transplanted organ (b), shown as Kaplan-Meier curves with 95% confidence intervals. P values are from log-rank tests
Fig. 2
Fig. 2
Survival after diagnosis of pancreatic cancer in solid organ transplant recipients, for patients with local/regional stage cancer (a) or distant stage cancer (b). Results are shown as Kaplan–Meier curves with 95% CI confidence intervals for liver recipients and recipients of other organs. P values are from log-rank tests
See this image and copyright information in PMC

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