title: Spectrum of cancer risk among US solid organ transplant recipients.
abstract: BACKGROUND
  Solid organ transplant recipients have elevated cancer risk due to immunosuppression and oncogenic viral infections. Because most prior research has concerned kidney recipients, large studies that include recipients of differing organs can inform cancer etiology.
  
  
  OBJECTIVE
  To describe the overall pattern of cancer following solid organ transplantation.
  
  
  METHODS
  Cohort study using linked data on solid organ transplant recipients from the US Scientific Registry of Transplant Recipients (1987-2008) and 13 state and regional cancer registries.
  
  
  METHODS
  Standardized incidence ratios (SIRs) and excess absolute risks (EARs) assessing relative and absolute cancer risk in transplant recipients compared with the general population.
  
  
  RESULTS
  The registry linkages yielded data on 175,732 solid organ transplants (58.4% for kidney, 21.6% for liver, 10.0% for heart, and 4.0% for lung). The overall cancer risk was elevated with 10,656 cases and an incidence of 1375 per 100,000 person-years (SIR, 2.10 [95% CI, 2.06-2.14]; EAR, 719.3 [95% CI, 693.3-745.6] per 100,000 person-years). Risk was increased for 32 different malignancies, some related to known infections (eg, anal cancer, Kaposi sarcoma) and others unrelated (eg, melanoma, thyroid and lip cancers). The most common malignancies with elevated risk were non-Hodgkin lymphoma (n = 1504; incidence: 194.0 per 100,000 person-years; SIR, 7.54 [95% CI, 7.17-7.93]; EAR, 168.3 [95% CI, 158.6-178.4] per 100,000 person-years) and cancers of the lung (n = 1344; incidence: 173.4 per 100,000 person-years; SIR, 1.97 [95% CI, 1.86-2.08]; EAR, 85.3 [95% CI, 76.2-94.8] per 100,000 person-years), liver (n = 930; incidence: 120.0 per 100,000 person-years; SIR, 11.56 [95% CI, 10.83-12.33]; EAR, 109.6 [95% CI, 102.0-117.6] per 100,000 person-years), and kidney (n = 752; incidence: 97.0 per 100,000 person-years; SIR, 4.65 [95% CI, 4.32-4.99]; EAR, 76.1 [95% CI, 69.3-83.3] per 100,000 person-years). Lung cancer risk was most elevated in lung recipients (SIR, 6.13 [95% CI, 5.18-7.21]) but also increased among other recipients (kidney: SIR, 1.46 [95% CI, 1.34-1.59]; liver: SIR, 1.95 [95% CI, 1.74-2.19]; and heart: SIR, 2.67 [95% CI, 2.40-2.95]). Liver cancer risk was elevated only among liver recipients (SIR, 43.83 [95% CI, 40.90-46.91]), who manifested exceptional risk in the first 6 months (SIR, 508.97 [95% CI, 474.16-545.66]) and a 2-fold excess risk for 10 to 15 years thereafter (SIR, 2.22 [95% CI, 1.57-3.04]). Among kidney recipients, kidney cancer risk was elevated (SIR, 6.66 [95% CI, 6.12-7.23]) and bimodal in onset time. Kidney cancer risk also was increased in liver recipients (SIR, 1.80 [95% CI, 1.40-2.29]) and heart recipients (SIR, 2.90 [95% CI, 2.32-3.59]).
  
  
  CONCLUSIONS
  Compared with the general population, recipients of a kidney, liver, heart, or lung transplant have an increased risk for diverse infection-related and unrelated cancers.
authors: National Cancer Institute, 6120 Executive Blvd, EPS 7076, Rockville, MD 20892, USA. engelse@exchange.nih.gov
authors: Eric A
authors: EA
authors: Engels
authors: Ruth M
authors: RM
authors: Pfeiffer
authors: Joseph F
authors: JF
authors: Fraumeni
authors: Bertram L
authors: BL
authors: Kasiske
authors: Ajay K
authors: AK
authors: Israni
authors: Jon J
authors: JJ
authors: Snyder
authors: Robert A
authors: RA
authors: Wolfe
authors: Nathan P
authors: NP
authors: Goodrich
authors: A Rana
authors: AR
authors: Bayakly
authors: Christina A
authors: CA
authors: Clarke
authors: Glenn
authors: G
authors: Copeland
authors: Jack L
authors: JL
authors: Finch
authors: Mary Lou
authors: ML
authors: Fleissner
authors: Marc T
authors: MT
authors: Goodman
authors: Amy
authors: A
authors: Kahn
authors: Lori
authors: L
authors: Koch
authors: Charles F
authors: CF
authors: Lynch
authors: Margaret M
authors: MM
authors: Madeleine
authors: Karen
authors: K
authors: Pawlish
authors: Chandrika
authors: C
authors: Rao
authors: Melanie A
authors: MA
authors: Williams
authors: David
authors: D
authors: Castenson
authors: Michael
authors: M
authors: Curry
authors: Ruth
authors: R
authors: Parsons
authors: Gregory
authors: G
authors: Fant
authors: Monica
authors: M
authors: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007108:Immune Tolerance; D016867:Immunocompromised Host; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D016377:Organ Transplantation / Q000009:adverse effects*; D012042:Registries / Q000706:statistics & numerical data; D012306:Risk; D014481:United States / Q000453:epidemiology; D055815:Young Adult