title: Effect of immunosuppression for primary renal disease on the risk of cancer in subsequent renal transplantation:  a population-based retrospective cohort study.
abstract: BACKGROUND
  To measure the risk of cancer in renal transplantation for recipients who had previously been treated with immunosuppressive agents for primary renal disease.
  
  
  METHODS
  A retrospective population-based cohort study of 5970 renal transplant recipients in Australia registered on the Australia and New Zealand Dialysis and Transplant Registry between 1982 and 1997 and followed until 2007. Data about the incidence of a range of cancer types from this Registry were compared with cancer incidence data for the general population matched for cancer type, year of incidence, age, and gender derived from national cancer records. Outcome measures for each cancer group with or without pretransplantation immunosuppression were cancer-specific standardized incidence ratios and a multivariate hazard ratio (HR) standardized to 1.
  
  
  RESULTS
  For those treated with pretransplantation immunosuppression, the risks for four cancer groups during renal transplantation were significantly increased: anogenital cancer (HR, 3.13; confidence interval [CI], 1.92-5.11; P<0.0001), non-Hodgkin's lymphoma (HR, 2.37; CI, 1.53-3.68; P=0.0001), breast cancer (HR, 2.52; CI, 1.13-5.61; P=0.024), and urinary tract cancer (excluding kidney) (HR, 1.84; CI, 1.13-3.01; P=0.015). However, the risks of cancer in the oral cavity and pharynx, kidney, thyroid, colon, leukemia, lung, melanoma, prostate, and stomach were not significantly increased.
  
  
  CONCLUSIONS
  Pretransplantation immunosuppression for primary renal disease increases the risks of four cancer types in renal transplantation while sparing the others. Patients in whom this treatment is being considered should be informed of these risks.
authors.affiliation: Newcastle Transplant Unit, Division of Surgery, John Hunter Hospital, Newcastle, NSW, Australia. Adrian.Hibberd@hnehealth.nsw.gov.au
authors.forename: Adrian D
authors.initials: AD
authors.lastname: Hibberd
authors.forename: Paul R
authors.initials: PR
authors.lastname: Trevillian
authors.forename: John H
authors.initials: JH
authors.lastname: Wlodarczyk
authors.forename: Dante G
authors.initials: DG
authors.lastname: Kemp
authors.forename: Ann M
authors.initials: AM
authors.lastname: Stein
authors.forename: Alastair H B
authors.initials: AH
authors.lastname: Gillies
authors.forename: Munish K
authors.initials: MK
authors.lastname: Heer
authors.forename: Anslie G R
authors.initials: AG
authors.lastname: Sheil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D007223:Infant; D007674:Kidney Diseases / Q000188:drug therapy* / Q000276:immunology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents