De Novo malignancy after heart, kidney, and liver transplant: A nationwide study in Taiwan

Chun Chieh Yeh, Arshad Khan, Chih Hsin Muo, Horng Ren Yang, Ping Chun Li, Chao Hsiang Chang, Ta Liang Chen, Long Bin Jeng, Chien Chang Liao

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Objectives: In the Asian population, patterns and risk factors for de novo malignancies after solid-organ transplant are not well understood. Materials and Methods: Insurance claims from Taiwan’s National Health Institute Research Database from 1997 to 2011 revealed 687 deceased-donor heart transplant recipients, 5038 kidney transplant recipients (50% living related-donor, 50% deceased-donor transplants), and 2127 liver transplant recipients (mainly living related-donor transplants, 30% deceased-donor transplants). During the follow-up period, rates of malignancy incidence were calculated with standardization based on national age, sex, and year-specific incidence. We used multivariate regression analyses to determine risk factors of posttransplant de novo malignancies. Results: Compared with the general population, several de novo cancers were more common posttransplant (P < .05): lung cancer (2.6-fold), non-melanoma skin cancer (5.8-fold), and non-Hodgkin lymphoma (5.4-fold) in heart recipients; transitional cell carcinoma (31.4-fold), renal cell carcinoma (37.3-fold), and non-Hodgkin lymphoma (3.6-fold) in kidney recipients; and gastric cancer (3.0-fold) and lymphatic-hematopoietic malignancy (4.5-fold) in liver recipients. Independent risk factors for posttransplant malignancy in kidney transplant recipients were increased age, female, hepatitis B virus, and mycophenolate use (adjusted hazard ratio 1.5; 95% confidence interval, 1.2-1.8; P < .001). In liver transplant recipients, old age was an independent risk factor. Kidney transplant recipients without diabetes or hypertension had higher risk of transitional cell carcinoma (adjusted hazard ratio 3.0; 95% confidence interval, 2.1-4.4; P < .001) and renal cell carcinoma (adjusted hazard ratio 1.9; 95% confidence interval, 1.1-3.3; P < .05). Conclusions: Regional endemic epidemiologic factors play significant roles in the development of de novo cancers, particularly in kidney transplant recipients due to causes of renal failure other than diabetes and hypertension. Each regional organ transplant program should tailor and establish its surveillance protocol based on epidemiologic data. However, the type and intensity of surveillance require further and long-term investigations in this patient cohort.

Original languageEnglish
Pages (from-to)224-233
Number of pages10
JournalExperimental and Clinical Transplantation
Volume18
Issue number2
DOIs
Publication statusPublished - 2020

Keywords

  • Asian population
  • Cancer
  • Posttransplant
  • Solid organ
  • Survival

ASJC Scopus subject areas

  • Transplantation

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