Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia.
Transplantation. 2023 Jun 1;107(6):1359-1364. doi: 10.1097/TP.0000000000004493. Epub 2023 May 23.
Cancer incidence and mortality may change with varying kidney allograft function and after graft loss. We aimed to quantify cancer incidence and mortality during periods with a functioning graft and after graft loss.
We included all adult Australians aged 20 and above who commenced kidney replacement therapy between 1982 and 2014 using data from Australia and New Zealand Dialysis and Transplant Registry. We calculated the standardized incidence ratios and standardized mortality ratios (standardized against the Australian general population) for dialysis patients and transplant recipients during periods with a functioning graft and after graft loss.
A total of 44 765 dialysis patients without transplants, 13 443 with first kidney transplants, 2951 after first graft loss, 1010 with second transplants, and 279 after second graft loss were followed for 274 660 patient-years. Cancer incidence and mortality (per 100 000 patient-years) were 1564 and 760 in dialysis patients, 1564 and 689 in recipients of first transplants, 1188 and 390 after first graft loss, 1525 and 693 after second transplants, and 1645 and 779 after second graft loss. Cancer standardized incidence ratios and standardized mortality ratios (95% confidence intervals) were 1.15 (1.11-1.20) and 1.29 (1.21-1.36) for dialysis patients, 2.03 (1.94-2.13) and 2.50 (2.33-2.69) for recipients following their first transplant, 1.55 (1.29-1.85) and 1.40 (1.00-1.90) after first graft loss, 2.18 (1.79-2.63) and 3.00 (2.23-3.96) for second transplants, 2.59 (1.56-4.04) and 3.82 (1.75-7.25) after second graft loss.
In kidney transplant recipients, cancer incidence and mortality are highest during periods with a functioning graft and remained higher than in the general population even after graft loss.
癌症的发病率和死亡率可能会随着肾脏移植物功能的变化以及移植物丢失而改变。我们旨在量化有功能移植物和移植物丢失后的癌症发病率和死亡率。
我们纳入了所有在 1982 年至 2014 年间接受肾脏替代治疗的澳大利亚 20 岁及以上的成年人，这些数据来自澳大利亚和新西兰透析和移植登记处。我们计算了有功能移植物和移植物丢失后的透析患者和移植受者的标准化发病率比和标准化死亡率比（与澳大利亚一般人群相比）。
共有 44765 名无移植的透析患者、13443 名首次肾移植患者、2951 名首次移植物丢失后患者、1010 名二次移植患者和 279 名二次移植物丢失后患者随访了 274660 患者年。癌症发病率和死亡率（每 100000 患者年）分别为透析患者 1564 例和 760 例，首次移植患者 1564 例和 689 例，首次移植物丢失后患者 1188 例和 390 例，二次移植患者 1525 例和 693 例，二次移植物丢失后患者 1645 例和 779 例。癌症标准化发病率比和标准化死亡率比（95%置信区间）分别为透析患者 1.15（1.11-1.20）和 1.29（1.21-1.36），首次移植后患者 2.03（1.94-2.13）和 2.50（2.33-2.69），首次移植物丢失后患者 1.55（1.29-1.85）和 1.40（1.00-1.90），二次移植后患者 2.18（1.79-2.63）和 3.00（2.23-3.96），二次移植物丢失后患者 2.59（1.56-4.04）和 3.82（1.75-7.25）。
在肾移植受者中，有功能移植物期间癌症的发病率和死亡率最高，即使在移植物丢失后，仍高于一般人群。
