In a study reported in JAMA Oncology, Tao et al found that U.S. solid organ transplant (SOT) recipients with a history of pretransplant cancer were at increased risk of subsequent cancer.
Study Details
The cohort study used linked data from the U.S. Scientific Registry of Transplant Recipients and 34 population-based cancer registries, accounting for 92% of the U.S. SOT recipient population from 1995 to 2019. Incidence rate ratios (IRRs) compared risk of posttransplant cancer among SOT recipients with vs without pretransplant cancer, with adjustment for age, sex, and transplanted organ, for 581 combinations of pretransplant and posttransplant cancer types. IRRs were compared with standardized incidence ratios (SIRs), which described subsequent cancer risk among cancer survivors in the general population based on U.S. cancer registry data.
Key Findings
A total of 520,424 SOT recipients were included in the analysis. Median age at transplantation was 52 years.
Seven types of pretransplant cancer were significantly associated with a risk of the same type of cancer after transplantation: breast cancer (IRR = 3.71, 95% confidence interval [CI] = 3.04–4.48), melanoma of the skin (IRR = 10.4, 95% CI = 7.43–14.1), lung cancer (IRR = 3.65, 95% CI = 2.67–4.86), kidney cancer (IRR = 2.34, 95% CI = 1.94–2.79), urinary bladder cancer (IRR = 3.72, 95% CI = 2.44–5.39), liver cancer (IRR = 1.73, 95% CI = 1.39–2.14), and colorectal cancer (IRR = 2.38, 95% CI = 1.61–3.37).
Significant associations between pretransplant cancers and different posttransplant cancers included: liver cancer followed by lung cancer (IRR = 1.63, 95% CI = 1.48–1.80) and by prostate cancer (IRR = 1.71, 95% CI = 1.53–1.92); urinary bladder cancer followed by lung cancer (IRR = 2.55, 95% CI = 1.93–3.29); kidney cancer followed by thyroid cancer (IRR = 2.87, 95% CI = 1.87–4.17); and intrahepatic bile duct cancer followed by pancreatic cancer (IRR = 8.56, 95% CI = 3.66–16.7).
IRRs were lower than corresponding SIRs for cancer survivors in the general population for three combinations of pretransplant and posttransplant cancers: liver cancer followed by liver cancer, kidney cancer followed by kidney cancer, and lung cancer followed by lung cancer.
The investigators concluded: “This cohort study found that SOT recipients with pretransplant cancer had an elevated risk of posttransplant cancer, particularly of the same cancer type. These patterns likely reflect shared genetic or environmental risk factors. Among SOT recipients who had kidney, liver, or lung cancer before transplant, posttransplant cancer of the same organ may be associated with the underlying end-stage organ disease. Targeted cancer prevention and screening could benefit SOT recipients who have survived a cancer diagnosis before a transplant.”
Jun Tao, PhD, of Division of Cancer Epidemiology and Genetics, National Cancer Institute, is the corresponding author for the JAMA Oncology article.
DISCLOSURE: The study was supported by the Intramural Research Program of the National Institutes of Health. For full disclosures of the study authors, visit jamanetwork.com.
