Immunosuppression and the Risk of Post-Transplant Malignancy Among Cadaveric First Kidney Transplant Recipients

Authors

  • Rami T. Bustami,

    Corresponding author
    1. Scientific Registry of Transplant Recipients/University Renal Research and Education Association, Ann Arbor, MI
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  • Akinlolu O. Ojo,

    1. Scientific Registry of Transplant Recipients/University Renal Research and Education Association, Ann Arbor, MI
    2. Scientific Registry of Transplant Recipients/University of Michigan Kidney Epidemiology and Cost Center, Ann Arbor, MI
    3. Department of Veterans Affairs Medical Center, Division of Nephrology, University of Michigan, Ann Arbor, MI
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  • Robert A. Wolfe,

    1. Scientific Registry of Transplant Recipients/University of Michigan Kidney Epidemiology and Cost Center, Ann Arbor, MI
    2. Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
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  • Robert M. Merion,

    1. Scientific Registry of Transplant Recipients/University Renal Research and Education Association, Ann Arbor, MI
    2. Division of Transplantation, Department of Surgery, University of Michigan Health System, Ann Arbor, MI
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  • William M. Bennett,

    1. Solid Organ and Cellular Transplantation, Legacy Good Samaritan Hospital, and Northwest Renal Clinic, Portland, OR
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  • Suzanne V. McDiarmid,

    1. Pediatric Liver Transplantation, Department of Pediatrics and Surgery, UCLA Medical Center, Los Angeles, CA
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  • Alan B. Leichtman,

    1. Scientific Registry of Transplant Recipients/University Renal Research and Education Association, Ann Arbor, MI
    2. Department of Veterans Affairs Medical Center, Division of Nephrology, University of Michigan, Ann Arbor, MI
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  • Philip J. Held,

    1. Scientific Registry of Transplant Recipients/University Renal Research and Education Association, Ann Arbor, MI
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  • Friedrich K. Port

    1. Scientific Registry of Transplant Recipients/University Renal Research and Education Association, Ann Arbor, MI
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Abstract

The success of renal transplantation may be counterbalanced by serious adverse medical events. The effect of immunosuppression on the incidence of de novo neoplasms among kidney recipients should be monitored continuously. Using data from the Scientific Registry of Transplant Recipients, we studied the association of induction therapy by immunosuppression with antilymphocyte antibodies, with the development of de novo neoplasms. The study population included more than 41 000 recipients who received a cadaveric first kidney transplant after December 31, 1995, and were followed through February 28, 2002.

Using Cox regression models, we estimated time to development of two types of malignancy: de novo solid tumors and post-transplant lymphoproliferative disorder (PTLD). We made adjustments for several patient demographic factors and comorbidities.

Induction therapy was significantly associated with a higher relative risk (RR) of PTLD (RR = 1.78, p < 0.001), but not with a greater likelihood of de novo tumors (RR = 1.07, p = 0.42). Treatment with maintenance tacrolimus vs. cyclosporine showed a significantly different RR of developing de novo tumors for recipients with induction than for those not receiving induction (p = 0.024). These new estimates of the magnitude of malignancy risk associated with induction therapy may be useful for clinical practice.

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