title: Overall and cause-specific mortality in transplant recipients with a pretransplantation cancer history.
abstract: BACKGROUND
  It is unclear to what extent cancer history affects posttransplantation mortality in solid organ transplant recipients.
  
  
  METHODS
  We identified a Swedish population-based cohort of solid organ transplant recipients in the National Patient Register 1970 to 2008 and linked it to the Cancer and Cause-of-Death Register. Overall and cause-specific mortality was estimated using Cox regression.
  
  
  RESULTS
  Of 10,448 eligible recipients, 416 (4%) had a prior malignancy unrelated to the indication for transplantation diagnosed 2 months or more before surgery (median, 5.7 years). Mortality among cancer history recipients was 30% increased after transplantation, compared with other recipients (adjusted hazard ratio [HR], 1.3; 95% confidence interval [CI], 1.1-1.5; P<0.001), driven by cancer-specific death with no increase in cardiovascular, infectious, or other noncancer mortality. An increased rate of death due to cancer history was primarily observed among nonkidney recipients (adjusted HR(nonkidney), 1.8; 95% CI, 1.3-2.5; HR(kidney), 1.2; 95% CI, 1.0-1.4). Rates were greatest for patients with waiting times of 5 years or less but persisted with waiting times more than 10 years among kidney and nonkidney recipients with prior aggressive cancer types (gastrointestinal, breast, kidney/urothelial, and hematologic malignancies).
  
  
  CONCLUSIONS
  We conclude that organ transplant recipients with cancer history are at a moderately increased rate of death after transplantation, driven primarily by death due to cancer recurrence.
authors.affiliation: Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Christina
authors.initials: C
authors.lastname: Brattström
authors.forename: Fredrik
authors.initials: F
authors.lastname: Granath
authors.forename: Gustaf
authors.initials: G
authors.lastname: Edgren
authors.forename: Karin E
authors.initials: KE
authors.lastname: Smedby
authors.forename: Henryk E
authors.initials: HE
authors.lastname: Wilczek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D016377:Organ Transplantation / Q000401:mortality*; D016016:Proportional Hazards Models