Risk of Colorectal Cancer After Solid Organ Transplantation in the United States. Issue 3 (5th January 2016)

• Record Type: Journal Article
• Authors: Safaeian, M.; Robbins, H. A.; Berndt, S. I.; Lynch, C. F.; Fraumeni, J. F.; Engels, E. A.
• Is Part Of: American journal of transplantation. Volume 16:Issue 3(2016:Mar.)
• Page Start: 960
• Page End: 967
• Publication Date: 2016-01-05
• Subjects: Scope: health services and outcomes research -- translational research / science -- Discipline: organ transplantation in general -- Focus: cancer / malignancy / neoplasia: risk factors -- epidemiology; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.13549
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract: Solid organ transplant recipients have increased colorectal cancer (CRC) risk. We assessed CRC risk among transplant recipients and identified factors contributing to this association. The US transplant registry was linked to 15 population‐based cancer registries (1987–2010). We compared CRC risk in recipients to the general population by using standardized incidence ratios (SIRs) and identified CRC risk factors by using Poisson regression. Based on 790 cases of CRC among 224 098 transplant recipients, the recipients had elevated CRC risk (SIR 1.12, 95% confidence interval [CI] 1.04 to 1.20). The increase was driven by an excess of proximal colon cancer (SIR 1.69, 95% CI 1.53 to 1.87), while distal colon cancer was not increased (SIR 0.93, 95% CI 0.80 to 1.07), and rectal cancer was reduced (SIR 0.64, 95% CI 0.54 to 0.76). In multivariate analyses, CRC was increased markedly in lung recipients with cystic fibrosis (incidence rate ratio [IRR] 12.3, 95% CI 6.94 to 21.9, vs. kidney recipients). Liver recipients with primary sclerosing cholangitis and inflammatory bowel disease also had elevated CRC risk (IRR 5.32, 95% CI 3.73 to 7.58). Maintenance therapy with cyclosporine and azathioprine was associated with proximal colon cancer (IRR 1.53, 95% CI 1.05 to 2.23). Incidence was not elevated in a subgroup of kidney recipients treated with tacrolimus and mycophenolate mofetil, pointing to the relevance of the identified risk factors. Transplant recipients have increased proximal colon cancer risk, likely related to underlying medical conditions (cystic fibrosis and primary sclerosing cholangitis) and specific immunosuppressive regimens. Abstract : Using data from the large U.S. Transplant Cancer Match Study, the authors show that solid organ transplant recipients have an increased risk of proximal colon cancer, in part related to underlying medical conditions and specific immunosuppressive regimens.