Risk of skin cancer and other malignancies in kidney, liver, heart and lung transplant recipients 1970 to 2008—A Swedish population-based study

Authors

  • Britta Krynitz,

    Corresponding author
    1. Department of Pathology and Cytology, Karolinska University Laboratories, Stockholm, Sweden
    2. Unit of Dermatology and Venereology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
    • Department of Pathology and Cytology, F46 Huddinge, Karolinska University Laboratories, 14186 Stockholm, Sweden
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    • Tel: +46-8-58587847, Fax: +46-8-58581020

  • Gustaf Edgren,

    1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet and Department of Epidemiology, Harvard School of Public Health, Boston, MA
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  • Bernt Lindelöf,

    1. Unit of Dermatology and Venereology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
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  • Eva Baecklund,

    1. Unit of Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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  • Christina Brattström,

    1. Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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  • Henryk Wilczek,

    1. Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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  • Karin E. Smedby

    1. Unit of Clinical Epidemiology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
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Abstract

Organ transplant recipients are at increased risk of a wide range of malignancies, especially cutaneous squamous cell carcinomas (SCC). Few previous population-based studies have quantified and compared cancer risks according to graft type and with long-term follow-up. Using nationwide Swedish registers, we identified 10,476 recipients transplanted from 1970 to 2008 and followed them for cancer occurrence. Relative risks of cancer in comparison with the general population were expressed as standardized incidence ratios (SIR) and within the transplanted cohort as incidence rate ratios (IRR). During a total follow-up of 93,432 person-years, patients were diagnosed with 1,175 cancers excluding SCC, and with 2,231 SCC, SIRcancer excl SCC 2.4 (95% CI, 2.2–2.5); SIRSCC 121 (95% CI, 116–127). Cancer risks were most increased among heart and/or lung recipients SIRcancer excl SCC 3.3 (95% CI, 2.8–4.0); SIRSCC 198 (95% CI, 174–224), followed by kidney SIRcancer excl SCC 2.3 (95% CI, 2.1–2.4); SIRSCC 121 (95% CI, 116–127) and liver recipients SIRcancer excl SCC 2.3 (95% CI, 1.9–2.8); SIRSCC 32 (95% CI, 24–42). During follow-up, risk of cancer excluding SCC remained stable while risk of SCC tripled over 20 years irrespective of graft type, partly due to a subgroup of patients developing new SCCs at a rapidly increasing rate. In summary, post-transplant cancer risk varied by transplanted organ and by cancer site, with the bulk of the excess risk driven by an exceptionally high and accelerating risk of SCC. These findings underscore the importance of regular skin screening in organ transplant recipients.

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