title: Cancer risk and mortality after kidney transplantation: a population-based study on differences between Danish centres using standard immunosuppression with and without glucocorticoids.
abstract: Kidney recipients receive immunosuppression to prevent graft rejection, and long-term outcomes such as post-transplant cancer and mortality may vary according to the different protocols of immunosuppression.
  
  
  
  A national register-based historical cohort study was conducted to examine whether post-transplant cancer and all-cause mortality differed between Danish renal transplantation centres using standard immunosuppressive protocols including steroids (Centres 2, 3, 4) or a steroid-free protocol (Centre 1). The Danish Nephrology Registry, the Danish Civil Registration System, the Danish National Cancer Registry and the Danish National Patient Register were used. A historical cohort of 1450 kidney recipients transplanted in 1995-2005 was followed up with respect to post-transplant cancer and death until 31 December 2011.
  
  
  
  Compared with Center 1 the adjusted post-transplant cancer risk was 6-39% lower in Centre 3 [hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.67-1.32], in Centre 2 (HR 0.72, 95% CI 0.52-0.98) and in Centre 4 (HR 0.61, 95% CI 0.44-0.83). Compared with Center 1, the adjusted post-transplant mortality was 21-55% higher in Centre 4 (HR 1.21, 95% CI 0.91-1.61), in Centre 3 (HR 1.35, 95% CI 0.98-1.86) and in Centre 2 (HR 1.55, 95% CI 1.17-2.05). On average, post-transplant cancer was associated with a 4-fold increase in the risk of death (HR 4.25, 95% CI 3.36-5.38).
  
  
  
  There was a tendency of a higher post-transplant cancer occurrence, but lower all-cause mortality, in the Danish transplantation centre that adhered to a standard steroid-free immunosuppressive protocol.
authors: Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense Denmark.|Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.
authors: Henriette
authors: H
authors: Engberg
authors: Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense Denmark.|Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark.
authors: Sonja
authors: S
authors: Wehberg
authors: Department of Nephrology, Odense University Hospital, Odense, Denmark.
authors: Claus
authors: C
authors: Bistrup
authors: Department of Medicine, Zealand University Hospital, Roskilde, Denmark.
authors: James
authors: J
authors: Heaf
authors: Department of Nephrology, Copenhagen University Hospital, Copenhagen, Denmark.
authors: Søren Schwartz
authors: SS
authors: Sørensen
authors: Department of Nephrology, Odense University Hospital, Odense, Denmark.
authors: Helle Charlotte
authors: HC
authors: Thiesson
authors: Department of Nephrology, Herlev Hospital, Herlev, Denmark.
authors: Jesper Melchior
authors: JM
authors: Hansen
authors: Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark.
authors: My
authors: M
authors: Svensson
authors: OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark.|OPEN, Odense Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
authors: Anders
authors: A
authors: Green
authors: Department of Medicine, Zealand University Hospital, Roskilde, Denmark.
authors: Peter
authors: P
authors: Marckmann
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005938:Glucocorticoids / Q000627:therapeutic use*; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000276:immunology / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents
keywords: Danish national health registries; kidney transplantation; mortality; post-transplant cancer; steroids