Spectrum of cancer risk among US solid organ transplant recipients
Open accessAbstract
CONTEXT: Solid organ transplant recipients have elevated cancer risk due to immunosuppression and oncogenic viral infections. Because most prior research has concerned kidney recipients, large studies that include recipients of differing organs can inform cancer etiology. OBJECTIVE: To describe the overall pattern of cancer following solid organ transplantation. DESIGN, SETTING, AND PARTICIPANTS: Cohort study using linked data on solid organ transplant recipients from the US Scientific Registry of Transplant Recipients (1987-2008) and 13 state and regional cancer registries. MAIN OUTCOME MEASURES: Standardized incidence ratios (SIRs) and excess absolute risks (EARs) assessing relative and absolute cancer risk in transplant recipients compared with the general population. RESULTS: The registry linkages yielded data on 175,732 solid organ transplants (58.4% for kidney, 21.6% for liver, 10.0% for heart, and 4.0% for lung). The overall cancer risk was elevated with 10,656 cases and an incidence of 1375 per 100,000 person-years (SIR, 2.10 [95% CI, 2.06-2.14]; EAR, 719.3 [95% CI, 693.3-745.6] per 100,000 person-years). Risk was increased for 32 different malignancies, some related to known infections (eg, anal cancer, Kaposi sarcoma) and others unrelated (eg, melanoma, thyroid and lip cancers). The most common malignancies with elevated risk were non-Hodgkin lymphoma (n = 1504; incidence: 194.0 per 100,000 person-years; SIR, 7.54 [95% CI, 7.17-7.93]; EAR, 168.3 [95% CI, 158.6-178.4] per 100,000 person-years) and cancers of the lung (n = 1344; incidence: 173.4 per 100,000 person-years; SIR, 1.97 [95% CI, 1.86-2.08]; EAR, 85.3 [95% CI, 76.2-94.8] per 100,000 person-years), liver (n = 930; incidence: 120.0 per 100,000 person-years; SIR, 11.56 [95% CI, 10.83-12.33]; EAR, 109.6 [95% CI, 102.0-117.6] per 100,000 person-years), and kidney (n = 752; incidence: 97.0 per 100,000 person-years; SIR, 4.65 [95% CI, 4.32-4.99]; EAR, 76.1 [95% CI, 69.3-83.3] per 100,000 person-years). Lung cancer risk was most elevated in lung recipients (SIR, 6.13 [95% CI, 5.18-7.21]) but also increased among other recipients (kidney: SIR, 1.46 [95% CI, 1.34-1.59]; liver: SIR, 1.95 [95% CI, 1.74-2.19]; and heart: SIR, 2.67 [95% CI, 2.40-2.95]). Liver cancer risk was elevated only among liver recipients (SIR, 43.83 [95% CI, 40.90-46.91]), who manifested exceptional risk in the first 6 months (SIR, 508.97 [95% CI, 474.16-545.66]) and a 2-fold excess risk for 10 to 15 years thereafter (SIR, 2.22 [95% CI, 1.57-3.04]). Among kidney recipients, kidney cancer risk was elevated (SIR, 6.66 [95% CI, 6.12-7.23]) and bimodal in onset time. Kidney cancer risk also was increased in liver recipients (SIR, 1.80 [95% CI, 1.40-2.29]) and heart recipients (SIR, 2.90 [95% CI, 2.32-3.59]). CONCLUSION: Compared with the general population, recipients of a kidney, liver, heart, or lung transplant have an increased risk for diverse infection-related and unrelated cancers.
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Solid organ transplantation recipients have been excluded from clinical trials because of worries concerning alloimmunity, organ rejection, and an increased risk of developing de novo cancer after solid organ transplantation.
“Solid organ transplantation (SOT) recipients have been excluded from clinical trials because of worries concerning alloimmunity, organ rejection, and an increased risk of developing de novo cancer after SOT.154”
From Autoimmune diseases and immune-checkpoint inhibitors for cancer therapy: Review of the literature and personalized risk-based prevention strategy (2020) · cites this paper as [154]
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- Authors
- Engels, E. A., Pfeiffer, R. M., Fraumeni, J. F., Kasiske, B. L., Israni, A. K., Snyder, J. J., Wolfe, R. A., Goodrich, N. P., Bayakly, A. R., Clarke, C. A., Copeland, G., Finch, J. L., Fleissner, M. L., Goodman, M. T., Kahn, A., Koch, L., Lynch, C. F., Madeleine, M. M., Pawlish, K., Rao, C., Williams, M. A., Castenson, D., Curry, M., Parsons, R., Fant, G., & Lin, M.
- Affiliations
- National Institutes of Health (US)
- Arbor Research Collaborative for Health (US)
- Cancer Prevention Institute of California (US)
- Michigan Department of Health and Human Services (US)
- Connecticut Agricultural Experiment Station (US)
- University of Hawaiʻi at Mānoa (US)
- Illinois Department of Public Health (US)
- University of Iowa (US)
- Fred Hutch Cancer Center (US)
- New Jersey Department of Health (US)
- Texas Department of State Health Services (US)
- Information Management Services (US)
- United States Department of Health and Human Services (US)
- Corresponding author
- Engels, Eric A.
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2011-11-02
- Volume
- 306
- Issue
- 17
- Pages
- 1891
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC3310893
- OpenAlex
- W1964106115
- Cited by
- 1,524
- References
- 43
- Citations by year
- 2026: 83 · 2025: 100 · 2024: 100 · 2023: 89 · 2022: 106 · 2021: 114 · 2020: 134 · 2019: 124 · 2018: 107 · 2017: 114 · 2016: 108 · 2015: 106 · 2014: 97 · 2013: 83 · 2012: 55
- FWCI
- 37.37
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01pc54405-9-0-0, n01pc35143-20-0-1, n01pc35139-25-0-11, n01pc35142-19-0-0, n01pc35137-18-0-2)
- National Cancer Institute (N01PC35139, HHSN261201000034 C, HHSN261201000036C, HHSN261201000035C, N01‐PC035137, N01 PC035143, N01 PC35142, HHSN261201000037C, N01-PC-54405, HHSN261201000035I, N01-PC-35 137, N01PC-35143, N01 PC035139, HHSN261201000024C, N01 PC035142, N01 PC054405, ZIACP010150)
- National Center for Chronic Disease Prevention and Health Promotion (5U58DP000824-04, 5U58DP000812-03, U58 DP000812, U58 DP000817, U58 DP000805, U58 DP000807, U58 DP000848-04, U58 DP000832, 5U58DP000817-05, U58 DP000824, U58/DP000808, #1U58DP000807-01, 5658DP 000805-04, U58 DP000848, 5U58/DP000808-03)
- Topics
- Health Sciences › Medicine › Oncology › Viral-associated cancers and disorders
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
- Keywords
- solid organ transplant recipients, cancer risk, immunosuppression, non-Hodgkin lymphoma, lung cancer, Kaposi's sarcoma, anal cancer, melanoma, thyroid cancer, lip cancer, hepatitis C, cytomegalovirus, Epstein-Barr virus, post-transplant lymphoproliferative disorder
- MeSH terms
- Adolescent, Adult, Aged, Child, Child, Preschool, Female, Humans, Immune Tolerance, Infant, Male, Middle Aged, Neoplasms, Registries, Risk, United States, Cohort Studies, Incidence, Organ Transplantation, Immunocompromised Host, Young Adult
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