title: Standardised incidence ratios (SIRs) for cancer after renal transplant in systemic lupus erythematosus (SLE) and non-SLE recipients.
abstract: OBJECTIVE
  We investigated malignancy risk after renal transplantation in patients with and without systemic lupus erythematosus (SLE).
  
  
  METHODS
  Using the United States Renal Data System from 2001 to 2009, 143 652 renal transplant recipients with and without SLE contributed 585 420 patient-years of follow-up to determine incident cancers using Medicare claims codes. We calculated standardised incidence ratios (SIRs) of cancer by group using age, sex, race/ethnicity-specific and calendar year-specific cancer rates compared with the US population.
  
  
  RESULTS
  10 160 cancers occurred at least 3 months after renal transplant. Overall cancer risk was increased in both SLE and non-SLE groups compared with the US general population, SIR 3.5 (95% CI 2.1 to 5.7) and SIR 3.7 (95% CI 2.4 to 5.7), respectively. Lip/oropharyngeal, Kaposi, neuroendocrine, thyroid, renal, cervical, lymphoma, liver, colorectal and breast cancers were increased in both groups, whereas only melanoma was increased in SLE and lung cancer was increased in non-SLE. In Cox regression analysis, SLE status (HR 1.1, 95% CI 0.9 to 1.3) was not associated with increased risk of developing cancer, adjusted for other independent risk factors for developing cancer in renal transplant recipients. We found that smoking (HR 2.2, 95% CI 1.2 to 4.0), cytomegalovirus positivity at time of transplant (HR 1.3, 95% CI 1.2 to 1.4), white race (HR 1.2, 95% CI 1.2 to 1.3) and older recipient age at time of transplantation (HR 1.0 95% CI 1.0 to 1.2) were associated with an increased risk for development of cancer, whereas shorter time on dialysis, Epstein-Barr virus or HIV were associated with a lower risk for development of cancer.
  
  
  CONCLUSIONS
  Cancer risk in renal transplant recipients appeared similar in SLE and non-SLE subjects, aside from melanoma. Renal transplant recipients may need targeted counselling regarding surveillance and modifiable risk factors.
authors.affiliation: Division of Rheumatology, Department of Medicine , Feinberg School of Medicine, Northwestern University , Chicago, Illinois , USA.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Ramsey-Goldman
authors.affiliation: Department of Medicine , SUNY Downstate Medical Center , Brooklyn, New York , USA.
authors.forename: Amarpali
authors.initials: A
authors.lastname: Brar
authors.affiliation: Division of Rheumatology, Department of Medicine , Feinberg School of Medicine, Northwestern University , Chicago, Illinois , USA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Richardson
authors.affiliation: Department of Medicine , SUNY Downstate Medical Center , Brooklyn, New York , USA.
authors.forename: Moro O
authors.initials: MO
authors.lastname: Salifu
authors.affiliation: Division of Rheumatology, Department of Medicine , University of Calgary , Calgary, Alberta , Canada.
authors.forename: Ann
authors.initials: A
authors.lastname: Clarke
authors.affiliation: Department of Epidemiology and Biostatistics , McGill University , Montreal, Quebec , Canada.
authors.forename: Sasha
authors.initials: S
authors.lastname: Bernatsky
authors.affiliation: Division of Research , SUNY Downstate School of Medicine , Brooklyn, New York , USA.
authors.forename: Dimitre G
authors.initials: DG
authors.lastname: Stefanov
authors.affiliation: Walter Reed National Military Medical Center & Uniformed Services University , Bethesda, Maryland , USA.
authors.forename: Rahul M
authors.initials: RM
authors.lastname: Jindal
keywords: SLE; USRDS; cancer after kidney transplant; cancer risk SLE; kidney transplant