J Korean Med Sci.  2020 May;35(20):e166. 10.3346/jkms.2020.35.e166.

Risk of Graft Failure in Kidney Recipients with Cured Post-Transplant Cancer

• Kim JE
• Min Si
• Lee H
• Ha J
• Kim YS
• Han SS

• KMID: 2500847
• DOI: http://doi.org/10.3346/jkms.2020.35.e166

Abstract

Background
Post-transplant cancer (PTC) is a critical complication after kidney transplantation. However, whether successfully cured PTC affects the long-term graft outcome remains unclear.
Methods
We retrospectively reviewed 1,629 kidney transplant recipients from 1995 to 2017 after excluding patients with post-transplant hematologic or advanced non-curable cancers and who underwent allograft nephrectomy because of cancer. Cured PTCs were defined as cancers treated with curative methods and/or adjuvant therapy without recurrence during ≥ 2 years. Propensity score matching was performed to match cured PTC patients with cancer-naïve patients (i.e., non-PTC group).
Results
During the median period of 7 years (maximum, 23 years), 70 patients (4.3%) had cured PTCs. The PTC group showed significantly higher risks of death-censored graft failure (adjusted hazard ratio [HR], 2.56 [1.05–6.23]), class II donor-specific antibodies (adjusted HRs, 3.37 [1.30–8.71]), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (adjusted HR, 2.68 [1.43–5.02]) and random urine protein/creatinine ratio > 1 g (adjusted HR, 3.61 [1.92–6.79]) compared to non-PTC group. However, the risk of mortality was not different between the PTC and non-PTC groups. According to the cancer type, only urogenital cancer had a significant association with graft failure (adjusted HR, 4.26 [1.19–15.22]) and the gastrointestinal cancer showed elevated risk of T cell mediated rejection compared to non-PTC (adjusted HR, 20.44 [6.02–69.39]).
Conclusion
Appropriate monitoring of graft function is necessary in patients with cured PTCs.

Keyword

Cancer; Kidney Transplantation; Graft Function; Malignancy; Mortality

Figure

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  Fig. 1 Death-censored graft survival curves in patients with cured post-transplant cancer and patients without cancer. The P value in the graph was obtained by log-rank test.PTC = post-transplant cancer.

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  Fig. 2 Overall patient survival curves in patients with cured post-transplant cancer and patients without cancer. The P value in the graph was obtained by log-rank test.PTC = post-transplant cancer.

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