Cancer incidence after kidney transplant in the North Italy Transplant program (NITp)

P. Pedotti a, G. Rossini a, V. Arcuri b, M. Cardillo a, L. Boschiero c, R. Caldara d, F. Marchini e, C. Maresca f, G. Messa b, G. Montagnino a, D. Montanaro g, A. Nocera b, P. Rigotti e, E. Taioli a and Scalamogna Mario a

aIRCCS Ospedale Maggiore Policlinico, Milan; bA.O. San Martino, Genova; cA.O. di Verona, Verona; dIRCCS San Raffaele, Milan; eA.O. di Padova, Padova; fA. O. Ca' Fondello, Treviso; gA.O. Santa Maria della Misericordia, Udine - ITALY

Aim The risk of developing cancer increases among patients undergoing kidney transplant because of immunosuppressive treatment, and concurrent infections. We followed a cohort of patients who underwent kidney transplant between 1990 and 2000 and survived the acute phase (10 days) , to study the incidence of cancer. Methods Over 10 years, 2526 patients (1652 males, 874 females, mean age 43.9 ± 11.3 years) were transplanted in 7 out of 13 transplant centers of the NITp, Milano; the length of follow-up was 60.7 ± 35.6 months. In this period, 105 patients developed cancer (83 males, 22 females, mean age 47.1 ± 8.7 years), of which 27 were Kaposi (22 cutaneous, 5 visceral), 18 lymphoproliferative disease, 60 solid tumours (among which: 14 gastro-intestinal, 10 kidney, 6 breast, 7 lung, 4 bladder, 7 non basalioma skin cancer, 2 mesothelioma). Basal cell skin cancer was excluded from the analysis, because of under-reporting. Results The mean period between transplant and cancer was 39.1 ± 33.0 months (range: 0.5-128.0 months). The average cancer incidence was 4.2%. Thirteen cancers (12.4%) developed within 6 months from the transplant, 4 of which were solid tumours. A multivariate analysis showed that determinants of cancer development were increasing age, male gender and immunosuppression. Ten year mortality was significantly higher (p<0.0001) in cancer patients (30%) than among cancer free patients (5%). The relative risk of death in subjects with cancer was 1.9 (95% C.I.: 1.3-2.9). Conclusions These data underline the importance of patient surveillance, choice of immunosuppressive treatment and careful donor selection.

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Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Paris, France; February 9 - 12, 2002; in the section on Carcinogenesis.