title: Patient survival after the diagnosis of cancer in renal transplant recipients: a nested case-control study.
abstract: BACKGROUND
  Malignancy is a well-known complication after renal transplantation. We studied the influence of cancer on patient survival in the Dutch renal transplant population in a nested case-controlled analysis.
  
  
  METHODS
  Between March 1966 and May 2008, 15,227 renal transplantations in 12,805 recipients were registered in the Netherlands Organ Transplant Registry database. Total follow-up was 89,651 person years. We performed an analysis of patient and graft survival both from the day of transplantation and the diagnosis of cancer in recipients with invasive cancer. Recipients without invasive cancer, matched for gender, age, and year of transplantation, served as a control group. For the survival analysis after the diagnosis of cancer, the matched control group consisted of patients with a functioning graft at the moment the index patient was diagnosed with cancer.
  
  
  RESULTS
  Cancer had been registered in 908 (7.1%) patients, 630 (69%) of them died with functioning kidney, 510 (81%) because of their malignancy (at 8.2 years after transplantation, median). The median patient survival after transplantation was 11.9 vs. 16.8 years in the study and control group, respectively (P<0.001). The median patient and graft survival after the diagnosis of cancer was 2.1 vs. 8.3 (P<0.001) and 25 vs. 22.4 (P<0.001) years in the study and control group, respectively.
  
  
  CONCLUSIONS
  Mortality because of cancer is observed at a significantly later time after transplantation compared with mortality because of the other main lethal complications. It significantly affects life expectancy and carries a poor prognosis with a limited survival after diagnosis.
authors.affiliation: Department of Internal Medicine and Transplantation, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands. j.vandewetering.1@erasmusmc.nl
authors.forename: Jacqueline
authors.initials: J
authors.lastname: van de Wetering
authors.forename: Joke I
authors.initials: JI
authors.lastname: Roodnat
authors.forename: Aline C
authors.initials: AC
authors.lastname: Hemke
authors.forename: Andries J
authors.initials: AJ
authors.lastname: Hoitsma
authors.forename: Willem
authors.initials: W
authors.lastname: Weimar
mesh_terms: D016022:Case-Control Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008017:Life Expectancy; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality*; D013997:Time Factors