title: Risk of Colorectal Cancer After Solid Organ Transplantation in the United States.
abstract: Solid organ transplant recipients have increased colorectal cancer (CRC) risk. We assessed CRC risk among transplant recipients and identified factors contributing to this association. The US transplant registry was linked to 15 population-based cancer registries (1987-2010). We compared CRC risk in recipients to the general population by using standardized incidence ratios (SIRs) and identified CRC risk factors by using Poisson regression. Based on 790 cases of CRC among 224 098 transplant recipients, the recipients had elevated CRC risk (SIR 1.12, 95% confidence interval [CI] 1.04 to 1.20). The increase was driven by an excess of proximal colon cancer (SIR 1.69, 95% CI 1.53 to 1.87), while distal colon cancer was not increased (SIR 0.93, 95% CI 0.80 to 1.07), and rectal cancer was reduced (SIR 0.64, 95% CI 0.54 to 0.76). In multivariate analyses, CRC was increased markedly in lung recipients with cystic fibrosis (incidence rate ratio [IRR] 12.3, 95% CI 6.94 to 21.9, vs. kidney recipients). Liver recipients with primary sclerosing cholangitis and inflammatory bowel disease also had elevated CRC risk (IRR 5.32, 95% CI 3.73 to 7.58). Maintenance therapy with cyclosporine and azathioprine was associated with proximal colon cancer (IRR 1.53, 95% CI 1.05 to 2.23). Incidence was not elevated in a subgroup of kidney recipients treated with tacrolimus and mycophenolate mofetil, pointing to the relevance of the identified risk factors. Transplant recipients have increased proximal colon cancer risk, likely related to underlying medical conditions (cystic fibrosis and primary sclerosing cholangitis) and specific immunosuppressive regimens.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute/National Institutes of Health/Department of Health and Human Services, Bethesda, MD.
authors.forename: M
authors.initials: M
authors.lastname: Safaeian
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute/National Institutes of Health/Department of Health and Human Services, Bethesda, MD.
authors.forename: H A
authors.initials: HA
authors.lastname: Robbins
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute/National Institutes of Health/Department of Health and Human Services, Bethesda, MD.
authors.forename: S I
authors.initials: SI
authors.lastname: Berndt
authors.affiliation: Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA.
authors.forename: C F
authors.initials: CF
authors.lastname: Lynch
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute/National Institutes of Health/Department of Health and Human Services, Bethesda, MD.
authors.forename: J F
authors.initials: JF
authors.lastname: Fraumeni
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute/National Institutes of Health/Department of Health and Human Services, Bethesda, MD.
authors.forename: E A
authors.initials: EA
authors.lastname: Engels
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D066027:Transplant Recipients; D014481:United States / Q000453:epidemiology
keywords: Discipline: organ transplantation in general; Focus: cancer / malignancy / neoplasia: risk factors; Scope: health services and outcomes research; epidemiology; translational research / science