Clinical Topics & News
A recent study published online suggests that solid-organ transplant recipients (SOTRs) have a greater risk of dying of cancer compared with that of the general population. Investigators collected data from 3 Canadian registries and observed all SOTRs from January 1, 1991, through December 31, 2010, in a cohort study. The study identified 11,061 SOTRs with the median age of 49.
According to the study, common malignant neoplasms are typically curable in the general population and have a low mortality rate in those with transplants; but “once a malignant neoplasm is diagnosed, transplant recipients have worse outcomes than patients with cancer who have not undergone transplantation.” Comparing SOTRs with the general population, the study also showed that the standardized mortality ratios (SMR) were lowest in recipients aged > 60 years and highest in pediatric transplant recipients.
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They also recorded that the neoplasms indicating the need for a transplant caused 77% of the cancer deaths associated with pretransplant malignant neoplasm. To determine whether the patient had a preexisting malignant neoplasm or developed one after transplant, the investigators linked their participants to the Ontario Cancer Registry.
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Of all SOTRs, cancer was the second leading cause of death. Of these, lung cancer was the most common type of cancer. An examination of the incremental risk of death for SOTRs revealed that skin cancer had the highest SMR, followed by non-Hodgkin lymphoma (NHL). Although all SOTRs were at an increased risk of NHL, cardiothoracic recipients had the highest risk. Liver transplant recipients were at an increased risk of dying of posttransplant de novo liver cancers. Kidney transplant recipients had an increased risk of mortality from leukemia, melanoma, and prostate cancer.
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The investigators suggest a “tailored approach to cancer screening” for SOTRs and strategies to improve pre- and posttransplant lung cancer screening. Also, practitioners should recommend cancer preventative strategies, such as dietary changes, physical activity, sun protection, and exercise.
Source: Acuna SA, Fernandes KA, Daly C, et al. JAMA Oncol. 2016.
doi: 10.1001/jamaoncol.2015.5137.
