Higher Risk of Cancer Mortality in Solid-Organ Transplant Recipients


Key Points

  • Solid-organ transplant recipients had a 2.8-fold higher risk of cancer-related death vs the general population.
  • Risk was 1.9-fold higher in analysis excluding patients with pretransplantation malignancy.

In a study reported in JAMA Oncology, Acuna et al found a nearly threefold increased risk of cancer mortality in solid-organ transplant recipients compared with the general population in Ontario, Canada.

Study Details

The population-based cohort study included data from 11,061 patients who underwent solid- organ transplantation in Ontario between 1991 and 2010, including 6,516 kidney, 2,606 liver, 929 heart, and 705 lung transplantations, representing 85,557 person-years of follow-up through December 2011. Recipients had a median age of 49 years, and 64% were male.

Increased Risk

Of 3,068 deaths in the cohort, 603 (20%) were cancer-related. Cancer mortality was significantly higher in transplant recipients than in the general population (standardized mortality ratio [SMR] = 2.84, 95% confidence interval [CI] = 2.61–3.07). Risk remained higher (SMR = 1.93, 95% CI = 1.75–2.13) in analysis, excluding patients with pretransplantation cancers (n = 1,124). Increased risk was observed for all types of transplanted organs. No significant differences in standardized mortality ratio were observed according to sex. Mortality risk vs the general population was highest for children (SMR = 84.61, 95% CI = 52.00–128.40) and lowest for patients aged > 60 years (SMR = 1.88, 95% CI = 1.62–2.18).

Most cancer-related deaths (78%) occurred in patients with functioning grafts. Cancer was the second-leading cause of death for all recipients (20%) after cardiovascular disease (24%) and was the most common cause of death in liver transplant recipients (26%).

The investigators concluded: “Cancer death rate in [solid-organ transplant recipients] was increased compared with that expected in the general population; cancer was the second leading cause of death in these patients. Advances in prevention, clinical surveillance, and cancer treatment modalities for [solid-organ transplant recipients] are needed to reduce the burden of cancer mortality in this population.”

The study was supported by the Canadian Institutes of Health Research and the Institute for Clinical Evaluative Sciences.

Nancy N. Baxter, MD, PhD, of the University of Toronto, Institute of Health Policy, Management, and Education, is the corresponding author of the JAMA Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.