TY - JOUR
T1 - De Novo malignancy after heart, kidney, and liver transplant
T2 - A nationwide study in Taiwan
AU - Yeh, Chun Chieh
AU - Khan, Arshad
AU - Muo, Chih Hsin
AU - Yang, Horng Ren
AU - Li, Ping Chun
AU - Chang, Chao Hsiang
AU - Chen, Ta Liang
AU - Jeng, Long Bin
AU - Liao, Chien Chang
N1 - Funding Information:
This study is supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW 105-TDU-B-212-133019), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10501010037), the NRPB Stroke Clinical Trial Consortium (MOST 104-2325-B-039-005), the Tseng-Lien Lin Foundation, Taichung, Taiwan, the Taiwan Brain Disease Foundation, Taipei, Taiwan, and the Katsuzo and Kiyo Aoshima Memorial Funds, Japan. The authors have no conflicts of interest to disclose.
Funding Information:
From the 1School of Medicine, China Medical University, Taichung, Taiwan; the 2Department of Surgery, China Medical University Hospital, Taichung, Taiwan; the 3Division of Transplantation, University of Illinois at Chicago, Illinois, USA; the 4Division of Surgery, University of North Dakota, Grand Forks, North Dakota; the 5Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; the 6College of Medicine, China Medical University, Taichung, Taiwan; the 7Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; the 8Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; the 9School of Medicine, Taipei Medical University, Taipei, Taiwan; and the 10School of Chinese Medicine, China Medical University, Taichung, Taiwan Acknowledgements: This study is supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW105-TDU-B-212-133019), China Medical University Hospital, Academia Sinica Taiwan Biobank Stroke Biosignature Project (BM10501010037), the NRPB Stroke Clinical Trial Consortium (MOST 104-2325-B-039 -005), the Tseng-Lien Lin Foundation, Taichung, Taiwan, the Taiwan Brain Disease Foundation, Taipei, Taiwan, and the Katsuzo and Kiyo Aoshima Memorial Funds, Japan. The authors have no conflicts of interest to disclose. Corresponding author: Arshad Khan, Altru Health System and University of North Dakota, 711 Delmore Drive, Roseau, MN 56751, USA Phone: +1 218 463 1365 E-mail: abkhan98@gmail.com
Publisher Copyright:
© Başkent University 2020 Printed in Turkey. All Rights Reserved.
PY - 2020
Y1 - 2020
N2 - Objectives: In the Asian population, patterns and risk factors for de novo malignancies after solid-organ transplant are not well understood. Materials and Methods: Insurance claims from Taiwan’s National Health Institute Research Database from 1997 to 2011 revealed 687 deceased-donor heart transplant recipients, 5038 kidney transplant recipients (50% living related-donor, 50% deceased-donor transplants), and 2127 liver transplant recipients (mainly living related-donor transplants, 30% deceased-donor transplants). During the follow-up period, rates of malignancy incidence were calculated with standardization based on national age, sex, and year-specific incidence. We used multivariate regression analyses to determine risk factors of posttransplant de novo malignancies. Results: Compared with the general population, several de novo cancers were more common posttransplant (P < .05): lung cancer (2.6-fold), non-melanoma skin cancer (5.8-fold), and non-Hodgkin lymphoma (5.4-fold) in heart recipients; transitional cell carcinoma (31.4-fold), renal cell carcinoma (37.3-fold), and non-Hodgkin lymphoma (3.6-fold) in kidney recipients; and gastric cancer (3.0-fold) and lymphatic-hematopoietic malignancy (4.5-fold) in liver recipients. Independent risk factors for posttransplant malignancy in kidney transplant recipients were increased age, female, hepatitis B virus, and mycophenolate use (adjusted hazard ratio 1.5; 95% confidence interval, 1.2-1.8; P < .001). In liver transplant recipients, old age was an independent risk factor. Kidney transplant recipients without diabetes or hypertension had higher risk of transitional cell carcinoma (adjusted hazard ratio 3.0; 95% confidence interval, 2.1-4.4; P < .001) and renal cell carcinoma (adjusted hazard ratio 1.9; 95% confidence interval, 1.1-3.3; P < .05). Conclusions: Regional endemic epidemiologic factors play significant roles in the development of de novo cancers, particularly in kidney transplant recipients due to causes of renal failure other than diabetes and hypertension. Each regional organ transplant program should tailor and establish its surveillance protocol based on epidemiologic data. However, the type and intensity of surveillance require further and long-term investigations in this patient cohort.
AB - Objectives: In the Asian population, patterns and risk factors for de novo malignancies after solid-organ transplant are not well understood. Materials and Methods: Insurance claims from Taiwan’s National Health Institute Research Database from 1997 to 2011 revealed 687 deceased-donor heart transplant recipients, 5038 kidney transplant recipients (50% living related-donor, 50% deceased-donor transplants), and 2127 liver transplant recipients (mainly living related-donor transplants, 30% deceased-donor transplants). During the follow-up period, rates of malignancy incidence were calculated with standardization based on national age, sex, and year-specific incidence. We used multivariate regression analyses to determine risk factors of posttransplant de novo malignancies. Results: Compared with the general population, several de novo cancers were more common posttransplant (P < .05): lung cancer (2.6-fold), non-melanoma skin cancer (5.8-fold), and non-Hodgkin lymphoma (5.4-fold) in heart recipients; transitional cell carcinoma (31.4-fold), renal cell carcinoma (37.3-fold), and non-Hodgkin lymphoma (3.6-fold) in kidney recipients; and gastric cancer (3.0-fold) and lymphatic-hematopoietic malignancy (4.5-fold) in liver recipients. Independent risk factors for posttransplant malignancy in kidney transplant recipients were increased age, female, hepatitis B virus, and mycophenolate use (adjusted hazard ratio 1.5; 95% confidence interval, 1.2-1.8; P < .001). In liver transplant recipients, old age was an independent risk factor. Kidney transplant recipients without diabetes or hypertension had higher risk of transitional cell carcinoma (adjusted hazard ratio 3.0; 95% confidence interval, 2.1-4.4; P < .001) and renal cell carcinoma (adjusted hazard ratio 1.9; 95% confidence interval, 1.1-3.3; P < .05). Conclusions: Regional endemic epidemiologic factors play significant roles in the development of de novo cancers, particularly in kidney transplant recipients due to causes of renal failure other than diabetes and hypertension. Each regional organ transplant program should tailor and establish its surveillance protocol based on epidemiologic data. However, the type and intensity of surveillance require further and long-term investigations in this patient cohort.
KW - Asian population
KW - Cancer
KW - Posttransplant
KW - Solid organ
KW - Survival
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U2 - 10.6002/ect.2019.0210
DO - 10.6002/ect.2019.0210
M3 - Article
C2 - 32133940
AN - SCOPUS:85083332444
SN - 1304-0855
VL - 18
SP - 224
EP - 233
JO - Experimental and Clinical Transplantation
JF - Experimental and Clinical Transplantation
IS - 2
ER -
