Affiliation:
1. Department of Urology Taichung Veterans General Hospital Taichung Taiwan
2. School of Medicine National Yang‐Ming Chiao Tung University Taipei Taiwan
3. Department of Applied Chemistry National Chi Nan University Puli Nantou Taiwan
Abstract
AbstractBackgroundThe incidence of malignancies after successful kidney transplantation has historically been higher than in the general population, with adverse impact on clinical outcomes. However, uncertainty remains as to which cancers occur at what time points after kidney transplantation.MethodsWe conducted a longitudinal cohort study to investigate the temporal trends and topographic patterns of de novo malignancies to optimize surveillance protocols and improve transplant outcome in renal transplant recipients. Measurement of death and cancer events was performed to calculate the cumulative risk of events of interest.ResultsBetween 2000 and 2013, 3169 renal transplant recipients were retrospectively screened; 3035 (96%) of them met eligibility criteria and were evaluated with a follow‐up of 27612 person‐years. There was suboptimal overall survival and malignancy‐free survival in renal transplant recipients compared to reference groups (HR: 1.65; 95% CI: 1.50–1.82; p < .001; HR: 2.33; 95% CI: 2.04–2.66; p < .001, respectively). Among renal transplant recipients, urological malignancies were predominant (57.5%), followed by digestive tract malignancies (21.4%). The cancer risks of the urinary bladder and upper urinary tract were lower in male subjects (HR: .48; 95% CI: .33–.72; p < .001; HR: .34; 95% CI: .20–.59; p < .001, respectively). The temporal trends of urological malignancies among renal transplant recipients were expressed in a bimodal pattern, with M‐shaped peaks at 3 and 9 years, with gender disparity.ConclusionsIn renal transplant recipients, cancer occurrences are shown as M‐shaped twin peaks. Our study highlights that specific customized 'targeted' strategies for cancer surveillance programs are required to optimize posttransplant care.