Study: Cancer Is a Major Post-Tx Killer

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VANCOUVER—Cancer is the second most frequent cause of death in renal transplant recipients, according to a new Dutch study.

Using data from the Netherlands Organ Transplantation Registry, investigators at Erasmus Medical Center, University Hospital of Rotterdam, analyzed the outcomes of 12,805 patients who received 15,227 kidney transplants between March 1966 and May 2008. Invasive cancer developed in 908 patients (7.1%). Of the 3,173 of the patients who died with a functioning transplanted kidney, 510 (16.1%) died from cancer. The only other diagnosis that caused more deaths was cardiovascular disease, which was the cause of death for 1,117 (35.2%) of these patients.

Lead investigator Jacqueline van de Wetering, MD, presented study findings at the XIII International Congress of The Transplantation Society. Her team found the median age at transplantation for the 12,805 patients was 44 years, with a range of one to 80 years. The median patient survival post-transplant, censored for graft failure, was 18.9 years.

Other major causes of death in patients who died with a functioning graft were infection and gastrointestinal complications. A total of 505 patients (15.9%) died from infection after a median follow-up of 5.2 years and 161 patients (5.1%) died from GI complications after a median follow-up of 3.5 years.

The median time to death after transplantation among the patients who developed fatal invasive cancer was 8.2 years. When censored for graft failure, the median patient survival increased to 11.9 years.

Dr. Wetering and her colleagues compared the survival of patients with invasive cancer after renal transplantation to that of renal transplant patients with non-invasive cancer to help determine the effect of cancer on survival. The median failure-censored patient survival among these controls was 16.8 years.

“Mortality due to cancer is observed at a significantly later time after transplantation than mortality due to other main lethal complications,” Dr. van de Wetering concluded. “Early minimization of the immunosuppressive load could therefore be successful in the prevention of this late complication after kidney transplantation.”

Edward Geissler, PhD, who co-moderated the session at which Dr. van de Wetering presented the study findings, said the results are similar to those from a recent Australian-New Zealand registry analysis, in which cancer was nearly equal to cardiovascular disease as a leading cause of death in renal-transplant patients.

“The difference is likely due to the fact that the Dutch study did not include non-melanoma skin cancer,” said Dr. Geissler, Professor of Experimental Surgery at the University of Regensburg in Germany. A high level of sun exposure in Australia is a factor that could increase cancer deaths there, he noted. “Therefore, the Dutch study is more likely an underestimate of the problem, since non-melanoma skin cancer is the most frequent post-transplant malignancy that occurs.”

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