title: Time trends in risk and risk determinants of non-Hodgkin lymphoma in solid organ transplant recipients.
abstract: Organ transplantation increases risk of non-Hodgkin lymphoma (NHL), but long-term risk and time trends have seldom been evaluated. Immunosuppressive drug load is an important risk determinant, but the details are unclear. We studied NHL risk in a nationwide Swedish cohort of 11 081 graft recipients transplanted 1970-2008. Relative risks (RRs) were estimated within the cohort and versus the general population by age, sex, follow-up time and calendar period. NHL risk was also assessed by cumulative and average doses of immunosuppressive treatments in a nested case-control design throughout 1997 using conditional logistic regression. We observed 153 NHL cases during 97 853 years of follow-up. Compared with the general population, NHL risk was eightfold increased (RR 7.9; 95% confidence interval [CI] 6.6-9.4), and increased risks persisted after ≥15 years of follow-up among kidney (6.1; 95% CI 3.5-10) and nonkidney recipients (44; 14-103). Among nonkidney recipients, NHL risk was lower in the 2000s compared with the 1990s (0.5; 95% CI 0.3-1.0; p = 0.04). A high average dose of antithymocyte immunoglobulin (ATG) conferred an eightfold increased risk of NHL (OR 8.5; 95% CI 1.9-38). To conclude, posttransplant NHL risk decreased during the last decade among nonkidney recipients, possibly because of a more careful use of ATG, the introduction of new drugs, or both.
authors: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. pia.fernberg@ki.se
authors: P
authors: P
authors: Fernberg
authors: G
authors: G
authors: Edgren
authors: J
authors: J
authors: Adami
authors: A
authors: A
authors: Ingvar
authors: R
authors: R
authors: Bellocco
authors: G
authors: G
authors: Tufveson
authors: P
authors: P
authors: Höglund
authors: A
authors: A
authors: Kinch
authors: J F
authors: JF
authors: Simard
authors: E
authors: E
authors: Baecklund
authors: B
authors: B
authors: Lindelöf
authors: Y
authors: Y
authors: Pawitan
authors: K E
authors: KE
authors: Smedby
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000009:adverse effects; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012306:Risk; D013548:Sweden / Q000453:epidemiology; D013601:T-Lymphocytes / Q000276:immunology; D019737:Transplants / Q000009:adverse effects*
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents