title: De novo noncutaneous malignancies after kidney transplantation are associated with an increased risk of graft failure: results from a time-dependent analysis on 672 patients.
abstract: The aim of this study was to evaluate the association between cancer occurrence and risk of graft failure in kidney transplant recipients. From November 1998 to November 2013, 672 adult patients received their first kidney transplant from a deceased donor and had a minimum follow-up of 6 months. During a median follow-up of 4.7 years (3523 patient-years), 47 patients developed a nonmelanoma skin cancer (NMSC) and 40 a noncutaneous malignancy (NCM). A total of 59 graft failures were observed. The failure rate was 6 per 100 patient-year (pt-yr) after NCM versus 1.5 per 100 pt-yr in patients without NCM. In a time-dependent multivariable model, the occurrence of NCM appeared to be associated with failure (HR = 3.27; 95% CI = 1.44-7.44). The effect of NCM on the cause-specific graft failure was different (P = 0.002) when considering events due to chronic rejection (HR = 0.55) versus other causes (HR = 15.59). The reduction of the immunosuppression after NCM was not associated with a greater risk of graft failure. In conclusion, our data suggest that post-transplant NCM may be a strong risk factor for graft failure, particularly for causes other than chronic rejection.
authors.affiliation: Unit of Medical Statistics and Cancer Epidemiology, Center of Oncological Prevention (CPO) Piemonte, University of Eastern Piedmont, Novara, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Cena
authors.affiliation: Nephrology and Kidney Transplant Unit, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy. claudio.musetti@med.uniupo.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Musetti
authors.affiliation: Nephrology and Kidney Transplant Unit, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Quaglia
authors.affiliation: Unit of Medical Statistics and Cancer Epidemiology, Center of Oncological Prevention (CPO) Piemonte, University of Eastern Piedmont, Novara, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Magnani
authors.affiliation: Nephrology and Kidney Transplant Unit, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Stratta
authors.affiliation: Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bagnardi
authors.affiliation: Nephrology and Kidney Transplant Unit, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cantaluppi
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D012306:Risk; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: chronic rejection; graft failure; kidney transplantation; malignancy; nonmelanoma skin cancer; post-transplant lymphoprolipherative disorder