Immunosuppression and the Risk of Post-Transplant Malignancy Among Cadaveric First Kidney Transplant Recipients
Article first published online: 6 OCT 2003
American Journal of Transplantation
Volume 4, Issue 1, pages 87–93, January 2004
How to Cite
Bustami, R. T., Ojo, A. O., Wolfe, R. A., Merion, R. M., Bennett, W. M., McDiarmid, S. V., Leichtman, A. B., Held, P. J. and Port, F. K. (2004), Immunosuppression and the Risk of Post-Transplant Malignancy Among Cadaveric First Kidney Transplant Recipients. American Journal of Transplantation, 4: 87–93. doi: 10.1046/j.1600-6135.2003.00274.x
- Issue published online: 18 NOV 2003
- Article first published online: 6 OCT 2003
- Received 7 May 2003, revised 22 July 2003 and accepted for publication 1 August 2003
- Antilymphocyte antibodies;
- cadaveric kidney transplantation;
- de novo tumors;
- induction therapy;
- risk factors
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.