title: Risk of Thyroid Cancer Among Solid Organ Transplant Recipients.
abstract: Solid organ transplant recipients have an elevated incidence of thyroid cancer. We evaluated a wide range of potential risk factors in a cohort of 229 300 U.S. solid organ transplant recipients linked with 15 stage/regional cancer registries (1987-2012). Incidence rate ratios (IRRs) were adjusted for age, sex, race/ethnicity, transplanted organ, year of transplantation, and time since transplantation. Hazard ratios (HRs) for death and/or graft failure were adjusted for age, sex, race/ethnicity, transplanted organ, and year of transplantation. After transplantation, 356 thyroid cancers were diagnosed. Thyroid cancer incidence was 2.50-fold higher in transplant recipients than the general population (95% confidence interval [CI] 2.25-2.77). Among recipients of different organs, kidney recipients had the highest incidence of thyroid cancer (IRR = 1.26, 95% CI 1.03-1.53). Elevated thyroid cancer incidence was associated with cholestatic liver disease/cirrhosis as an indication for liver transplantation (IRR = 1.69, 95% CI 1.09-2.63), hypertensive nephrosclerosis as an indication for kidney transplantation (IRR = 1.41, 95% CI 1.03-1.94), and longer prior dialysis among kidney recipients (5+ vs. <1 year, IRR = 1.92, 95% CI 1.32-2.80; p-trend <0.01). Posttransplantation diagnosis of thyroid cancer was associated with modestly increased risk of death (HR = 1.33, 95% CI 1.02-1.73). Overall, our results suggest that end-stage organ disease and longer duration of dialysis may contribute to higher thyroid cancer incidence in transplant recipients.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD.
authors.forename: C M
authors.initials: CM
authors.lastname: Kitahara
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD.
authors.forename: E L
authors.identifier: http://orcid.org/0000-0002-5835-0201
authors.initials: EL
authors.lastname: Yanik
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: P W
authors.initials: PW
authors.lastname: Ladenson
authors.affiliation: University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI.
authors.forename: B Y
authors.initials: BY
authors.lastname: Hernandez
authors.affiliation: Department of Epidemiology, University of Iowa, Iowa City, IA.
authors.forename: C F
authors.initials: CF
authors.lastname: Lynch
authors.affiliation: Cancer Epidemiology Services, New Jersey Department of Health, Trenton, NJ.
authors.forename: K S
authors.initials: KS
authors.lastname: Pawlish
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD.
authors.forename: E A
authors.initials: EA
authors.lastname: Engels
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011379:Prognosis; D012042:Registries; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D066027:Transplant Recipients; D014481:United States / Q000453:epidemiology
keywords: cancer/malignancy/neoplasia: risk factors; clinical research/practice; epidemiology; immunosuppression/immune modulation; kidney transplantation/nephrology; organ transplantation in general; translational research/science