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Effect of reduced immunosuppression after kidney transplant failure on risk of cancer: population based retrospective cohort study

Objective To compare cancer incidence in kidney transplant recipients during periods of transplant function (and immunosuppression) and after transplant failure (when immunosuppression is ceased or reduced). Design, setting, and participants Nationwide, population based retrospective cohort study of...

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Autores principales: van Leeuwen, Marina T, Webster, Angela C, McCredie, Margaret R E, Stewart, John H, McDonald, Stephen P, Amin, Janaki, Kaldor, John M, Chapman, Jeremy R, Vajdic, Claire M, Grulich, Andrew E
Formato: Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2820609/
https://www.ncbi.nlm.nih.gov/pubmed/20150194
http://dx.doi.org/10.1136/bmj.c570
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author van Leeuwen, Marina T
Webster, Angela C
McCredie, Margaret R E
Stewart, John H
McDonald, Stephen P
Amin, Janaki
Kaldor, John M
Chapman, Jeremy R
Vajdic, Claire M
Grulich, Andrew E
author_facet van Leeuwen, Marina T
Webster, Angela C
McCredie, Margaret R E
Stewart, John H
McDonald, Stephen P
Amin, Janaki
Kaldor, John M
Chapman, Jeremy R
Vajdic, Claire M
Grulich, Andrew E
author_sort van Leeuwen, Marina T
collection PubMed
description Objective To compare cancer incidence in kidney transplant recipients during periods of transplant function (and immunosuppression) and after transplant failure (when immunosuppression is ceased or reduced). Design, setting, and participants Nationwide, population based retrospective cohort study of 8173 Australian kidney transplant recipients registered on the Australia and New Zealand Dialysis and Transplant Registry who first received a transplant during 1982-2003. Incident cancers were ascertained using linkage with national cancer registry records. Main outcome measures Cancer-specific standardised incidence ratios for periods of transplant function and for dialysis after transplant failure. Incidence was compared between periods using multivariate incidence rate ratios adjusted for current age, sex, and duration of transplantation. Results All cases of Kaposi’s sarcoma occurred during transplant function. Standardised incidence ratios were significantly elevated during transplant function, but not during dialysis after transplant failure, for non-Hodgkin’s lymphoma, lip cancer, and melanoma. For each of these cancers, incidence was significantly lower during dialysis after transplant failure in multivariate analysis (incidence rate ratios 0.20 (95% CI 0.06 to 0.65) for non-Hodgkin’s lymphoma, 0.04 (0.01 to 0.31) for lip cancer, and 0.16 (0.04 to 0.64) for melanoma). In contrast, standardised incidence ratios during dialysis after transplant failure remained significantly elevated for leukaemia and lung cancer, and cancers related to end stage kidney disease (kidney, urinary tract, and thyroid cancers), with thyroid cancer incidence significantly higher during dialysis after transplant failure (incidence rate ratio 6.77 (2.64 to 17.39)). There was no significant difference in incidence by transplant function for other cancers. Conclusions The effect of immunosuppression on cancer risk is rapidly reversible for some, but not all, cancer types. Risk reversal was mainly observed for cancers with a confirmed infectious cause. Risk of other cancers, especially those related to end stage kidney disease, remained significantly increased after reduction of immunosuppression.
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spelling pubmed-28206092010-02-18 Effect of reduced immunosuppression after kidney transplant failure on risk of cancer: population based retrospective cohort study van Leeuwen, Marina T Webster, Angela C McCredie, Margaret R E Stewart, John H McDonald, Stephen P Amin, Janaki Kaldor, John M Chapman, Jeremy R Vajdic, Claire M Grulich, Andrew E BMJ Research Objective To compare cancer incidence in kidney transplant recipients during periods of transplant function (and immunosuppression) and after transplant failure (when immunosuppression is ceased or reduced). Design, setting, and participants Nationwide, population based retrospective cohort study of 8173 Australian kidney transplant recipients registered on the Australia and New Zealand Dialysis and Transplant Registry who first received a transplant during 1982-2003. Incident cancers were ascertained using linkage with national cancer registry records. Main outcome measures Cancer-specific standardised incidence ratios for periods of transplant function and for dialysis after transplant failure. Incidence was compared between periods using multivariate incidence rate ratios adjusted for current age, sex, and duration of transplantation. Results All cases of Kaposi’s sarcoma occurred during transplant function. Standardised incidence ratios were significantly elevated during transplant function, but not during dialysis after transplant failure, for non-Hodgkin’s lymphoma, lip cancer, and melanoma. For each of these cancers, incidence was significantly lower during dialysis after transplant failure in multivariate analysis (incidence rate ratios 0.20 (95% CI 0.06 to 0.65) for non-Hodgkin’s lymphoma, 0.04 (0.01 to 0.31) for lip cancer, and 0.16 (0.04 to 0.64) for melanoma). In contrast, standardised incidence ratios during dialysis after transplant failure remained significantly elevated for leukaemia and lung cancer, and cancers related to end stage kidney disease (kidney, urinary tract, and thyroid cancers), with thyroid cancer incidence significantly higher during dialysis after transplant failure (incidence rate ratio 6.77 (2.64 to 17.39)). There was no significant difference in incidence by transplant function for other cancers. Conclusions The effect of immunosuppression on cancer risk is rapidly reversible for some, but not all, cancer types. Risk reversal was mainly observed for cancers with a confirmed infectious cause. Risk of other cancers, especially those related to end stage kidney disease, remained significantly increased after reduction of immunosuppression. BMJ Publishing Group Ltd. 2010-02-11 /pmc/articles/PMC2820609/ /pubmed/20150194 http://dx.doi.org/10.1136/bmj.c570 Text en © van Leeuwen et al 2010 This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
spellingShingle Research
van Leeuwen, Marina T
Webster, Angela C
McCredie, Margaret R E
Stewart, John H
McDonald, Stephen P
Amin, Janaki
Kaldor, John M
Chapman, Jeremy R
Vajdic, Claire M
Grulich, Andrew E
Effect of reduced immunosuppression after kidney transplant failure on risk of cancer: population based retrospective cohort study
title Effect of reduced immunosuppression after kidney transplant failure on risk of cancer: population based retrospective cohort study
title_full Effect of reduced immunosuppression after kidney transplant failure on risk of cancer: population based retrospective cohort study
title_fullStr Effect of reduced immunosuppression after kidney transplant failure on risk of cancer: population based retrospective cohort study
title_full_unstemmed Effect of reduced immunosuppression after kidney transplant failure on risk of cancer: population based retrospective cohort study
title_short Effect of reduced immunosuppression after kidney transplant failure on risk of cancer: population based retrospective cohort study
title_sort effect of reduced immunosuppression after kidney transplant failure on risk of cancer: population based retrospective cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2820609/
https://www.ncbi.nlm.nih.gov/pubmed/20150194
http://dx.doi.org/10.1136/bmj.c570
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