title: The risk of cancer in recipients of living-donor, standard and expanded criteria deceased donor kidney transplants: a registry analysis.
abstract: BACKGROUND
  Kidneys from expanded criteria deceased donors may elicit a strong inflammatory response, predisposing recipients to an increased risk of cancer after transplantation. We aimed to determine the association between donor types and cancer risk after kidney transplantation.
  
  
  METHODS
  Using the Australian and New Zealand Dialysis and Transplant Registry, we assessed the association between different donor types (living donor, standard, and expanded criteria deceased donors) and the risk of cancer after kidney transplantation using adjusted Cox proportional hazard and competing risk models.
  
  
  RESULTS
  Over a median follow-up period of 4.4 years in 7,040 patients (34,684 patient-years), 468 patients (6.6%) developed cancer. The overall risks for cancer were 1,080, 1,444, and 2,018 per 100,000 patient-years for recipients of living donor, standard, and expanded criteria deceased donor kidneys, respectively. Compared to recipients of living-donor kidneys, recipients of expanded criteria deceased donor kidneys were at an increased risk of cancer (adjusted hazard ratio [HR], 1.52; 95% confidence interval [95% CI], 1.15-2.02; P = 0.004), particularly for genitourinary cancer (adjusted HR, 1.79; 95% CI, 1.03-3.10; P = 0.038) and post-transplant lymphoproliferative disease (adjusted HR, 2.72; 95% CI, 1.38-5.37; P = 0.004).
  
  
  CONCLUSIONS
  Recipients of expanded criteria deceased donor kidneys are at substantially increased risk of cancer, especially cancers with a viral etiology. Allocation of expanded criteria deceased donor kidneys to potential recipients should balance the harms, such as the excess risk of cancer against the survival gains and quality-of-life benefits associated with transplantation.
authors.affiliation: 1 Department of Medicine, Queen Mary Hospital, Hong Kong. 2 Department of Renal Medicine and University of Western Australia, Sir Charles Gairdner Hospital, Perth, Australia. 3 ANZDATA Registry, Adelaide, Australia. 4 Sydney School of Public Health, University of Sydney, New South Wales, Australia. 5 Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia. 6 Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales, Australia. 7 Address correspondence to: Germaine Wong, Centre for Transplant and Renal Research, Westmead Hospital, NSW 2145, Australia.
authors.forename: Maggie K M
authors.initials: MK
authors.lastname: Ma
authors.forename: Wai H
authors.initials: WH
authors.lastname: Lim
authors.forename: Robin M
authors.initials: RM
authors.lastname: Turner
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
mesh_terms: D000328:Adult; D001315:Australia; D005260:Female; D006801:Humans; D015994:Incidence; D007249:Inflammation; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009520:New Zealand; D011183:Postoperative Complications; D011336:Probability; D016016:Proportional Hazards Models; D011788:Quality of Life; D012042:Registries; D006435:Renal Dialysis; D012307:Risk Factors; D014019:Tissue Donors; D066027:Transplant Recipients