0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Cancer Mortality Among Recipients of Solid-Organ Transplantation in Ontario, Canada

Sergio A. Acuna, MD1,2; Kimberly A. Fernandes, MSc, Astat3; Corinne Daly, MSc2; Lisa K. Hicks, MD, MSc4; Rinku Sutradhar, PhD3,5; S. Joseph Kim, MD, PhD, MHS1,3,6; Nancy N. Baxter, MD, PhD1,2,3
[+] Author Affiliations
1Institute of Health Policy, Management and Education, University of Toronto, Toronto, Ontario, Canada
2Department of Surgery, Li Ki Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
3Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
4Division of Hematology/Oncology, St Michael’s Hospital, Toronto, Ontario, Canada
5Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
6Division of Nephrology, University Health Network, Toronto, Ontario, Canada
JAMA Oncol. 2016;2(4):463-469. doi:10.1001/jamaoncol.2015.5137.
Text Size: A A A
Published online

Importance  Solid-organ transplant recipients (SOTRs) are at greater risk of developing some cancers than the general population; however, because they are also at increased risk of mortality from noncancer causes, the effect of transplantation on cancer mortality is unclear.

Objective  To describe cancer mortality in SOTRs and to assess whether SOTRs are at increased risk of cancer mortality compared with the general population.

Design, Setting, and Participants  Population-based cohort study of patients who underwent solid-organ transplantation in Ontario, Canada, between 1991 and 2010 with 85 557 person-years of follow-up through December 31, 2011. Solid-organ transplantation was identified using the national transplant register and linked to the provincial cancer registry and administrative databases. The analysis was conducted between November 2013 and February 2015.

Exposure  Solid-organ transplantation.

Main Outcomes and Measures  Cancer mortality for SOTRs was compared with that of the general population using standardized mortality ratios (SMRs). Mortality and cause of death were ascertained by record linkage between the Canadian Organ Replacement Register, the Ontario Cancer Registry, and the Office of the Registrar General of Ontario death database.

Results  A total of 11 061 SOTRs were identified, including 6516 kidney, 2606 liver, 929 heart, and 705 lung transplantations. Recipients had a median (interquartile range) age of 49 (37-58) years, and 4004 (36.2%) were women. Of 3068 deaths, 603 (20%) were cancer related. Cancer mortality in SOTRs was significantly elevated compared with the Ontario population (SMR, 2.84 [95% CI, 2.61-3.07]). The risk remained elevated when patients with pretransplant malignant neoplasms (n = 1124) were excluded (SMR, 1.93 [95% CI, 1.75-2.13]). The increased risk was observed irrespective of transplanted organ. The SMR for cancer death after solid-organ transplantation was higher in children (SMR, 84.61 [95% CI, 52.00-128.40]) and lower in patients older than 60 years (SMR, 1.88 [95% CI, 1.62-2.18]) but remained elevated compared with the general population at all ages.

Conclusions and Relevance  Cancer death rate in SOTRs was increased compared with that expected in the general population; cancer was the second leading cause of death in these patients. Advances in prevention, clinical surveillance, and cancer treatment modalities for SOTRs are needed to reduce the burden of cancer mortality in this population.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Cumulative Incidence Function of Cancer and Noncancer Deaths by Years After Transplantation

Cancer and non–cancer-specific mortality cumulative incidence functions were compared according to Aly et al21 (P < .001).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Distribution of Cancer Deaths and Standardized Mortality Ratios (SMRs) by Cancer Site for All Cancer Deaths

Standardized mortality ratios are presented in a log scale, with symbols indicating SMR, and error bars, 95% CI. Patients with cause of death listed as ICD-9 238.77 (posttransplant lymphoproliferative disorder) were grouped with non-Hodgkin lymphoma–related deaths.

aMalignant neoplasms were classified as having a related or possible-related infectious etiology as described by Grulich et al18: Hodgkin and non-Hodgkin lymphoma (Epstein-Barr virus); Kaposi sarcoma (human herpesvirus 8); hepatocellular carcinoma (hepatitis B and C virus); gastric cancer (Helicobacter pylori); and malignant neoplasms from the cervix uteri, male and female genitalia, anus, oral cavity and pharynx, esophagus, larynx, eye, and nonmelanoma skin cancer (human papillomavirus).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Distribution of Cancer Deaths and Standardized Mortality Ratios (SMRs) by Cancer Site for Posttransplant de Novo Cancer Deaths in All Solid-Organ Transplant Recipients

Standardized mortality ratios are presented in a log scale, with symbols indicating SMR, and error bars, 95% CI.

aMalignant neoplasms were classified as having a related or possible-related infectious etiology as described by Grulich et al18: Hodgkin and non-Hodgkin lymphoma (Epstein-Barr virus); Kaposi sarcoma (human herpesvirus 8); hepatocellular carcinoma (hepatitis B and C virus); gastric cancer (Helicobacter pylori); and malignant neoplasms from the cervix uteri, male and female genitalia, anus, oral cavity and pharynx, esophagus, larynx, eye, and nonmelanoma skin cancer (human papillomavirus).

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

712 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();