Incidence of cancer after kidney transplant: results from the North Italy transplant program.
BACKGROUND
Patients undergoing kidney transplantation demonstrate a higher risk of developing cancer as the result of immunosuppressive treatment and concurrent infections.


METHODS
The incidence of cancer in a cohort of patients who underwent kidney transplantation between 1990 and 2000, and who survived the acute phase (10 days), was analyzed as part of the North Italy Transplant program.


RESULTS
A total of 3,521 patients underwent transplantation during a 10-year period in 10 of 13 participating centers; the length of follow-up after kidney transplant was 67.7+/-36.0 months. During the follow-up, 172 patients developed cancer (39 with Kaposi sarcoma, 38 with lymphoproliferative diseases, and 95 with carcinomas [17 kidney, 11 non-basal cell carcinoma of the skin, 10 colorectal, 8 breast, 7 gastric, 7 lung, 6 bladder, and 3 mesothelioma]). The average time to cancer development after transplant was 40.1+/-33.4 months (range 0-134 months). Twenty-four patients developed cancer within 6 months from the transplant (10 with carcinomas, 7 with Kaposi sarcoma, and 7 with lymphoproliferative diseases). Three patients demonstrated a second primary cancer. The average cancer incidence was 4.9%. The incidence of cancer was 0.01 per year. Independent determinants of cancer development were age, gender, and immunosuppressive protocol including induction. Ten-year mortality was significantly higher in patients with cancer (33.1%) than among patients without cancer (5.3%). The relative risk of death in subjects with cancer was 5.5 (confidence interval 4.1-7.4).


CONCLUSIONS
These preliminary data underline the importance of long-term surveillance of transplant recipients, choice of immunosuppressive treatment, and careful donor selection.
Pedotti
Paola
P
Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, Milan, Italy.
Cardillo
Massimo
M
Rossini
Giuseppe
G
Arcuri
Valentino
V
Boschiero
Luigino
L
Caldara
Rossana
R
Cannella
Giuseppe
G
Dissegna
Daniela
D
Gotti
Eliana
E
Marchini
Francesco
F
Maresca
Maria Cristina
MC
Montagnino
Giuseppe
G
Montanaro
Domenico
D
Rigotti
Paolo
P
Sandrini
Silvio
S
Taioli
Emanuela
E
Scalamogna
Mario
M
D000206:Actuarial Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy; D007680:Kidney Neoplasms / Q000453:epidemiology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors