Increased Cancer Mortality Rate Among Recipients of Solid-Organ Transplants

Key Points

  • Cancer mortality among solid-organ transplant recipients was significantly elevated compared with the general population, with a standardized mortality ratio of 2.84, according to a Canadian study.
  • The increased mortality risk was observed irrespective of transplanted organ and remained elevated when patients with pretransplant malignant neoplasms were excluded.
  • The standardized mortality ratio was higher for children receiving solid-organ transplantation and lower in patients older than 60 years but remained elevated compared with the general population at all ages.

Solid-organ transplant recipients have a higher rate of cancer mortality than what is expected in the general population, according to a Canadian study by Acuna et al published in JAMA Oncology. Cancer mortality among transplant recipients was significantly elevated compared with data for the Ontario population, with a standardized mortality ratio of 2.84 (95% confidence interval [CI], 2.61–3.07), the investigators found. “The increased risk was observed irrespective of transplanted organ,” they noted.

The population-based cohort study identified 11,061 patients who underwent solid-organ transplantation in Ontario between 1991 and 2010. This total included 6,516 kidney, 2,606 liver, 929 heart, and 705 lung transplantations. The 85,557 person-years of follow-up continued through December 31, 2011.

The median age of the transplant recipients was 49 years (range, 37–58 years), and 4,004 (36.2%) were women. “Of 3,068 deaths, 603 (20%) were cancer related,” Sergio A. Acuna, MD, of the University of Toronto, et al reported. “Although the risk of noncancer death exceeded cancer-related mortality (P < .001), the risk of cancer-related death increased steadily over time,” the researchers noted. Cancer was the second-leading cause of death overall for transplant recipients (20%) after cardiovascular disease (24%).

Lung Cancer the Most Common Cause

“Lung cancers were the most common cause of cancer death (n = 126 [21%]), followed by liver cancers (n = 107 [18%], most due to cancers that predated transplantation), non-Hodgkin lymphoma (NHL; n = 96 [16%]), and colorectal cancer (n = 43 [7%]),” the researchers reported.

The risk of cancer mortality “remained elevated when patients with pretransplant malignant neoplasms (n = 1,124) were excluded (standardized mortality ratio, 1.93 [95% CI, 1.75–2.13]),” the researchers wrote. Malignant neoplasm was the reason for transplantation in 442 patients (39%) with a history of pretransplant neoplasms; 234 patients (21%) had malignant neoplasms diagnosed around the time of transplantation; and 448 patients (40%) had malignant neoplasms in presumed remission.  

The mortality ratio was higher for children receiving solid-organ transplantation (standardized mortality ratio, 84.61 [95% CI, 52.00–128.40]) and lower in patients older than 60 years (standardized mortality ratio, 1.88 [95% CI, 1.62–2.18]) “but remained elevated compared with the general population at all ages,” the researchers found.

Tailored Approach to Screening

The incidence of cancer in transplant recipients “is expected to increase in the next 10 years as the median age of transplant recipients increases and improvements in survival with a functioning transplant lengthen exposure to immunosuppression,” the authors noted.

“A tailored approach to cancer screening is likely required for transplant recipients,” the investigators suggested. “Given the high mortality of lung cancers, strategies to improve pretransplant and posttransplant lung cancer screening may be necessary. Screening with low-dose computed tomography in high-risk groups such as thoracic organ recipients and patients with smoking history could be considered. Specific cancer screening strategies for liver cancers should be evaluated in hepatic transplant recipients and for melanoma, colorectal, oral cavity, and prostate cancer in kidney recipients. Finally, cancer preventive strategies such as limitation of sunlight exposure, sun protection, smoking cessation, reduction in alcohol consumption, dietary changes, and physical activity should also be considered.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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