Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.
School of Public Health, Loma Linda University, Loma Linda, California, USA.
Am J Transplant. 2022 Aug;22(8):2006-2015. doi: 10.1111/ajt.17082. Epub 2022 May 24.
Living kidney donors are screened for transmissible diseases including cancer. Outcomes following donation are excellent, but concern exists regarding development of chronic kidney disease, and cancer risk is unknown. We used linked transplant and cancer registry data to identify incident cancers among 84,357 kidney donors in the United States (1995-2017). We compared risk with the general population using standardized incidence ratios (SIRs). For selected cancers, we used Poisson regression to compare donors with 47,451 Adventist Health Study 2 (AHS-2) participants, who typically have healthy lifestyles. During follow-up, 2843 cancers were diagnosed in donors, representing an overall deficit (SIR 0.79, 95%CI 0.76-0.82). None of 46 specified cancer sites occurred in excess relative to the general population, and 15 showed significant deficits (SIR < 1.00). Compared with AHS-2 participants, donors had similar incidence of liver cancer, melanoma, breast cancer, and non-Hodgkin lymphoma but, starting 7 years after donation, elevated incidence of colorectal cancer (adjusted incidence rate ratio 2.07, 95%CI 1.54-2.79) and kidney cancer (2.97, 1.58-5.58, accounting for the presence of a single kidney in donors). Elevated kidney cancer incidence may reflect adverse processes in donors' remaining kidney. Nonetheless, cancer risk is lower than in the general population, suggesting that enhanced screening is unnecessary.
活体肾脏捐献者接受包括癌症在内的传染病筛查。捐献后的结果非常出色，但人们仍对慢性肾脏病的发展以及癌症风险表示担忧。我们使用已链接的移植和癌症登记数据，在美国（1995-2017 年）的 84357 名肾脏捐献者中确定了新发癌症。我们使用标准化发病比（SIR）与普通人群的风险进行比较。对于某些选定的癌症，我们使用泊松回归，将与通常生活方式健康的 47451 名 Adventist Health Study 2（AHS-2）参与者进行比较。在随访期间，在捐献者中诊断出 2843 例癌症，这代表整体不足（SIR 0.79，95%CI 0.76-0.82）。与普通人群相比，没有任何 46 个指定的癌症部位发病率过高，而 15 个部位的发病率明显不足（SIR<1.00）。与 AHS-2 参与者相比，捐献者的肝癌、黑色素瘤、乳腺癌和非霍奇金淋巴瘤的发病率相似，但在捐赠后 7 年开始，结直肠癌（调整后的发病率比 2.07，95%CI 1.54-2.79）和肾癌（2.97，1.58-5.58）的发病率升高，这是因为捐献者只有一个肾脏。肾癌发病率升高可能反映了捐献者剩余肾脏中的不良过程。尽管如此，癌症风险低于普通人群，这表明增强筛查是不必要的。
