Cancer risk and mortality after solid organ transplantation: A population‐based 30‐year cohort study in Finland. Issue 11 (3rd February 2022)

• Record Type: Journal Article
• Authors: Friman, Terhi Kristiina; Jäämaa‐Holmberg, Salla; Åberg, Fredrik; Helanterä, Ilkka; Halme, Maija; Pentikäinen, Markku O.; Nordin, Arno; Lemström, Karl B.; Jahnukainen, Timo; Räty, Riikka; Salmela, Birgitta
• Is Part Of: International journal of cancer. Volume 150:Issue 11(2022)
• Page Start: 1779
• Page End: 1791
• Publication Date: 2022-02-03
• Subjects: cancer risk -- mortality -- population‐based -- solid organ transplantation -- standardized incidence ratio; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.33934
• Languages: English
• ISSNs: 0020-7136

Abstract

Abstract: Cancer is a significant cause of morbidity and mortality after solid organ transplantation (SOT) and related to lifelong immunosuppression. This retrospective registry study assessed for the first time in Finland population‐based cancer risk and cancer mortality after all SOTs (lung and childhood transplantations included) as standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs). Data from transplant registries were linked with the data of Finnish Cancer Registry and Statistics Finland. We followed 6548 consecutive first SOT recipients from 1 January 1987 to 31 December 2016 translating to 66 741 person‐years (median follow‐up time 8.9 years [interquartile range 4.0‐15.1]). In total, 2096 cancers were found in 1483 patients (23% of all patients). Majority of cancers (53%) were nonmelanoma skin cancers (NMSCs). The overall SIR was 3.6 (95% confidence interval [CI]: 3.5‐3.8) and the SIR excluding NMSCs was 2.2 (95% CI: 2.0‐2.3). SIR for all cancers was highest for heart (5.0) and lowest for liver (2.7) recipients. Most common cancer types after NMSCs were non‐Hodgkin lymphoma (NHL), SIR 9.9 (95% CI: 8.5‐11.4) and kidney cancer, SIR 7.3 (95% CI: 6.0‐8.8). Cancer‐related deaths were 17% (n = 408) of all deaths after first month post transplantation. SMR for all cancers was 2.5 (95% CI: 2.2‐2.7) and for NHL 13.6 (95% CI: 10.7‐16.8). Notably, overall SIR for cancer was lower in later period (2000‐2016), 3.0 (95% CI: 2.8‐3.2), than in earlier period (1987‐1999), 4.3 (95% CI: 4.0‐4.5), P < .001. Decrease in cancer incidence was temporally associated with major changes in immunosuppression in the 2000s. Abstract : What's new? For solid organ transplant patients, the requirement for life‐long immunosuppression is associated with increased cancer risk and cancer mortality. Specifically in Finland, however, studies on cancer incidence after transplantation have been limited. Here, retrospective analyses of patients in Finland reveal an increased risk of cancer and increased cancer mortality after all solid organ transplantations. Nonmelanoma skin cancers accounted for the majority of malignancies among solid organ transplant patients, followed by non‐Hodgkin lymphoma and kidney cancer. Cancer mortality was increased 2.5‐fold among transplant patients, compared to the general population. Excess cancer risk was lower for more recent transplant recipients (2000‐2016).