title: Immunosuppression and the risk of post-transplant malignancy among cadaveric first kidney transplant recipients.
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.
authors.affiliation: Scientific Registry of Transplant Recipients/University Renal Research and Education Association, Ann Arbor, MI, USA. RBustami@urrea.org
authors.forename: Rami T
authors.initials: RT
authors.lastname: Bustami
authors.forename: Akinlolu O
authors.initials: AO
authors.lastname: Ojo
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolfe
authors.forename: Robert M
authors.initials: RM
authors.lastname: Merion
authors.forename: William M
authors.initials: WM
authors.lastname: Bennett
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: McDiarmid
authors.forename: Alan B
authors.initials: AB
authors.lastname: Leichtman
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Held
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
mesh_terms: D002102:Cadaver; D017690:Cell Transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D016030:Kidney Transplantation / Q000379:methods*; D016014:Linear Models; D016015:Logistic Models; D008214:Lymphocytes / Q000276:immunology; D008232:Lymphoproliferative Disorders / Q000276:immunology; D008297:Male; D016016:Proportional Hazards Models; D012306:Risk; D012307:Risk Factors; D013997:Time Factors; D019737:Transplants
chemical_list: D007166:Immunosuppressive Agents