An organ transplant is truly a gift to life to an individual suffering from a failure of their kidneys, liver, heart or lungs. The procedure can restore health to an otherwise doomed individual. Rejection of the transplant remains a problem. In addition, other problems can arise among transplant recipients. A new study by researchers at the University of Toronto assessed the risk of a cancer developing in a solid organ transplant. The findings were published online on January 7 in the journal JAMA Oncology.
The study authors note that solid-organ transplant recipients are at increased risk of developing some cancers than the general population; however, because they are also at increased risk of death from noncancerous causes, the effect of transplantation on cancer mortality is unclear. Therefore, they conducted a study to investigate cancer mortality among solid organ transplant recipients and to assess whether solid organ transplant recipients are at increased risk of cancer mortality compared to the general population.
The study group comprised patients who underwent solid-organ transplantation in Ontario, Canada, from 1991 through 2010 with 85,557 person-years of follow-up through December 31, 2011. Solid-organ transplant cases were derived from the national transplant register and linked to the provincial cancer registry and administrative databases. The analysis was conducted from November 2013 through February 2015. Mortality and cause of death were determined by record linkage between the Canadian Organ Replacement Register, the Ontario Cancer Registry, and the Office of the Registrar General of Ontario death database.
The investigators identified 11,061 cases of solid organ transplants, including 6,516 kidney, 2,606 liver, 929 heart, and 705 lung transplantations. The recipients had an average age of 49 (range: 37-58) years, and 4,004 (36.2%) were women. Of 3,068 deaths, 603 (20%) were cancer related. Cancer mortality in solid organ transplant recipients was significantly increased compared to the Ontario population. The risk remained elevated when patients with pre-transplant malignancies neoplasms (1,124 patients) were excluded. The increased risk was observed irrespective of transplanted organ. The risk for cancer death after solid-organ transplantation was higher in children and lower in patients older than 60 years; however, it remained elevated compared to the general population at all ages.
The authors concluded that cancer death rate in SOTRs was increased compared to that expected in the general population; cancer was the second leading cause of death in these patients. They recommended that advances in prevention, clinical surveillance, and cancer treatment modalities for SOTRs are needed to reduce the burden of cancer mortality in this population.