title: Cytomegalovirus and cancer after kidney transplantation: Role of the human leukocyte antigen system?
abstract: BACKGROUND
  The role of cytomegalovirus (CMV) in cancer development after transplantation remains uncertain. We aimed to determine the association between donor and recipient CMV serological status and the risk of cancer development after kidney transplantation.
  
  
  METHODS
  Using data from the Australian and New Zealand Dialysis and Transplant (ANZDATA) Registry, we assessed the association between CMV donor/recipient (D/R) serological status and the risk of solid organ cancers in primary adult deceased-donor kidney transplant patients between 1990 and 2012.
  
  
  RESULTS
  Of 8140 recipients, a total of 895 (11%) recipients developed incident cancers during a follow-up time of 51 555 person-years. Human leukocyte antigen (HLA) mismatches was an effect modifier between CMV serological status and cancer (P=.03 for interaction). In recipients who have received 0-2 HLA-ABDR mismatched kidneys, the adjusted hazard ratios for cancer incidence among those with CMV D-/R-, CMV D-/R+, and CMV D+/R- were 0.47 (95% confidence interval [CI]: 0.24-0.91), 1.42 (95% CI: 0.97-2.07), and 1.02 (95% CI: 0.67-1.57), respectively compared with the reference of CMV D+/R+. A similar association was not observed in those with >2 HLA-ABDR mismatches.
  
  
  CONCLUSIONS
  CMV D-/R- status was associated with a reduced risk of cancer in kidney transplant recipients who have received well-matched renal allografts, suggesting a potential role of HLA matching in cancer development.
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.|Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.affiliation: Renal Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia School of Medicine and Pharmacology, University of Western Australia, Western Australia Harry Perkins Institute of Medical Research, Verdun St. Nedlands, WA, Australia.
authors.forename: Aron
authors.initials: A
authors.lastname: Chakera
authors.affiliation: Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.affiliation: Central Clinical School, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia.
authors.forename: Steve C
authors.initials: SC
authors.lastname: Chadban
authors.affiliation: Department of Renal Medicine, Auckland City Hospital and Department of Medicine, Auckland University, Auckland, New Zealand.
authors.forename: Helen
authors.initials: H
authors.lastname: Pilmore
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.affiliation: Renal Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia School of Medicine and Pharmacology, University of Western Australia, Western Australia Harry Perkins Institute of Medical Research, Verdun St. Nedlands, WA, Australia.
authors.forename: Wai H
authors.initials: WH
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000453:epidemiology / Q000276:immunology* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000276:immunology*; D009520:New Zealand / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012698:Serologic Tests; D014184:Transplantation, Homologous / Q000009:adverse effects
chemical_list: D006680:HLA Antigens
keywords: 
  HLA
  ; cancer; cytomegalovirus; epidemiology; kidney transplantation; outcomes