title: Malignancy-related mortality following kidney transplantation is common.
abstract: There is a paucity of studies describing malignancy-related mortality after kidney transplantation. To help quantify this, we extracted data for all kidney-alone transplant procedures performed in England between April 2001 and March 2012. Data linkage analysis was performed between Hospital Episode Statistics and the Office for National Statistics to identify all deaths occurring in this cohort. Among 19,103 kidney transplant procedures analyzed (median follow-up 4.4 years), 2085 deaths occurred, of which 376 (18.0%) were due to malignancy (crude mortality rate 361 malignancy-related deaths per 100,000 person-years). Common sites of malignancy-related death were lymphoma (18.4%), followed by lung (17.6%) and renal (9.8%), with 14.1% unspecified. The risk of malignancy-related death increased with age: under 50 (0.8%), 50-59 (2.5%), 60-69 (4.8%), 70-79 (6.5%) and over 80 years (9.1%). Age- and gender-stratified malignancy-related mortality risk difference was higher in the transplant compared with the general population. Cox proportional hazard models identified increased age, pretransplant history of malignancy and deceased-donor kidney transplantation to be independently associated with risk for post-transplant death from malignancy. Thus, malignancy as a cause of post-kidney transplantation death is common and requires heightened surveillance.
authors.affiliation: Department of Nephrology and Transplantation, Renal Institute of Birmingham, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Daniela
authors.initials: D
authors.lastname: Farrugia
authors.affiliation: Medical School, University of Birmingham, Birmingham, UK.
authors.forename: Sophia
authors.initials: S
authors.lastname: Mahboob
authors.affiliation: Medical School, University of Birmingham, Birmingham, UK.
authors.forename: James
authors.initials: J
authors.lastname: Cheshire
authors.affiliation: Department of Medical Informatics, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Irena
authors.initials: I
authors.lastname: Begaj
authors.affiliation: Department of Medical Informatics, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Sajan
authors.initials: S
authors.lastname: Khosla
authors.affiliation: Department of Medical Informatics, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ray
authors.affiliation: Department of Nephrology and Transplantation, Renal Institute of Birmingham, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: Adnan
authors.initials: A
authors.lastname: Sharif
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000208:ethnology / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult