Cancer Incidence Before and After Kidney Transplantation | Dermatology | JAMA | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Kinlen LJ. Immunosuppression and cancer. In: Vainio H, Magee PN, McGregor DB, McMichael AJ, eds. Mechanisms of Carcinogenesis in Risk Identification. Lyon, France: International Agency for Research on Cancer; 1992:237-253
Birkeland SA, Storm JJ, Lamm LU.  et al.  Cancer risk after renal transplantation in the Nordic countries, 1964-1986.  Int J Cancer. 1995;60:183-1897829213Google ScholarCrossref
Birkeland SA, Lokkegaard H, Storm HH. Cancer risk in patients on dialysis and after renal transplantation.  Lancet. 2000;355:1886-188710866449Google ScholarCrossref
McDonald SP, Excell LANZDATA Registry Report 2005. Adelaide: Australia and New Zealand Dialysis and Transplant Registry; 2005
International Agency for Research on Cancer (IARC).  International Rules for Multiple Primary Cancers (ICD-O Third Edition). Lyon, France: IARC Press; 2004
Australian Institute of Health and Welfare (AIHW) and Australasian Association of Cancer Registries (AACR).  Cancer in Australia 2001. Canberra: Australian Institute of Health and Welfare; 2004. AIHW Cat. No. CAN 23. Cancer Series; No. 28
Jaro MA. Probabalistic linkage of large public health data files.  Stat Med. 1995;14:491-4987792443Google ScholarCrossref
Grulich AE, Wan X, Law MG, Coates M, Kaldor JM. Risk of cancer in people with AIDS.  AIDS. 1999;13:839-84310357384Google ScholarCrossref
Frisch M, Biggar RJ, Goedert JJ. Human papillomavirus-associated cancers in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome.  J Natl Cancer Inst. 2000;92:1500-151010995805Google ScholarCrossref
Li Y, Law M, McDonald A, Correll P, Kaldor JM, Grulich AE. Estimation of risk of cancers before occurrence of acquired immunodeficiency syndrome in persons infected with human immunodeficiency virus.  Am J Epidemiol. 2002;155:153-15811790679Google ScholarCrossref
Australian Institute of Health and Welfare (AIHW) and Australasian Association of Cancer Registries (AACR).  Cancer Survival in Australia, 2001, Part 2: Statistical Tables. Canberra: Australian Institute of Health and Welfare; 2001. AIHW Cat. No. CAN 14. Cancer Series; No. 19
South Australian Cancer Registry.  Epidemiology of Cancer in South Australia. Adelaide: South Australian Cancer Registry; 2000
World Health Organization.  International Statistical Classification of Diseases, 10th Revision (ICD-10). Geneva, Switzerland: World Health Organization; 1992
International Agency for Research on Cancer (IARC).  IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Hepatitis Viruses, Volume 59. Lyon, France: IARC Press; 1994
International Agency for Research on Cancer (IARC).  IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Human Immunodeficiency Viruses and Human T-cell Lymphotropic Viruses, Volume 67. Lyon, France: IARC Press; 1996
International Agency for Research on Cancer (IARC).  IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Epstein-Barr Virus and Kaposi's Sarcoma Herpesvirus/Human Herpesvirus 8, Volume 70. Lyon, France: IARC Press; 1997
International Agency for Research on Cancer (IARC).  IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Human Papillomaviruses, Volume 64. Lyon, France: IARC Press; 1995
Cogliano V, Baan R, Straif K.  et al. WHO International Agency for Research on Cancer.  Carcinogenicity of human papillomaviruses.  Lancet Oncol. 2005;6:20415830458Google ScholarCrossref
Goldblum SE, Reed WP. Host defenses and immunologic alterations associated with chronic hemodialysis.  Ann Intern Med. 1980;93:597-6137001976Google ScholarCrossref
Girndt M, Sester M, Sester U, Kaul H, Kohler H. Molecular aspects of T- and B-cell function in uremia.  Kidney Int. 2001;59:(suppl 78)  S206-S211Google Scholar
Winkelspecht B, Mueller-Lantzsch N, Kohler H. Serological evidence for reactivation of EBV infection due to uraemic immunodeficiency.  Nephrol Dial Transplant. 1997;12:2099-21049351072Google ScholarCrossref
Port FK, Ragheb NE, Schwartz AG, Hawthorne VM. Neoplasms in dialysis patients: a population-based study.  Am J Kidney Dis. 1989;14:119-1232787957Google Scholar
Vamvakas S, Bahner U, Heidland A. Cancer in end-stage renal disease: potential factors involved.  Am J Nephrol. 1998;18:89-959569948Google ScholarCrossref
Shaib Y, el-Serag HB. The epidemiology of cholangiocarcinoma.  Semin Liver Dis. 2004;24:115-12515192785Google ScholarCrossref
International Agency for Research on Cancer (IARC).  IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Schistosomes, Liver Flukes and Helicobacter pylori, Volume 61.  Lyon, France: IARC Press; 1994
Mayne ST, Morse DE, Winn DM. Cancers of the oral cavity and pharynx. In: Schottenfeld D, Fraumeni JF Jr, eds. Cancer Epidemiology and Prevention. 3rd ed. Oxford, England: Oxford University Press; 2006:686-687
Mitsuishi T, Ohara K, Kawashima M, Kobayashi S, Kawana S. Prevalence of human papillomavirus DNA sequences in verrucous carcinoma of the lip: genomic and therapeutic approaches.  Cancer Lett. 2005;222:139-14315863262Google ScholarCrossref
Grulich AE, Li Y, McDonald A, Correll PK, Law MG, Kaldor JM. Rates of non-AIDS-defining cancers in people with HIV infection before and after AIDS diagnosis.  AIDS. 2002;16:1155-116112004274Google ScholarCrossref
Grulich AE, Wan X, Coates M, Day P, Kaldor JM. Validation of a non-identifying method of linking cancer and AIDS register data.  J Epidemiol Biostat. 1996;1:207-212Google Scholar
Parkin DM, Whelan SL, Ferlay J, Teppo L, Thomas DBCancer Incidence in Five Continents, Volume VIII. Lyon, France: IARC Press; 2002. IARC Scientific Publication No. 155
Australian Institute of Health and Welfare.  2004 National Drug Strategy Household Survey: First Results. Canberra: Australian Institute of Health and Welfare; 2005. AIHW Cat. No. PHE 57
Original Contribution
December 20, 2006

Cancer Incidence Before and After Kidney Transplantation

Author Affiliations

Author Affiliations: National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia (Drs Vajdic, Law, Kaldor, and Grulich, and Ms van Leeuwen); Australia and New Zealand Dialysis and Transplant Registry, Queen Elizabeth Hospital, Adelaide, Australia (Drs McDonald, Chapman, and Webster); Disciplines of Medicine and Public Health, University of Adelaide, Adelaide, Australia (Dr McDonald); Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand (Drs McCredie and Stewart); and Centre for Transplant and Renal Research, Millennium Institute, Westmead Hospital, University of Sydney, Sydney, Australia (Drs Chapman and Webster).

JAMA. 2006;296(23):2823-2831. doi:10.1001/jama.296.23.2823

Context Immune suppression after organ transplantation is associated with a markedly increased risk of nonmelanoma skin cancer and a few virus-associated cancers. Although it is generally accepted that other cancers do not occur at increased rates, there have been few long-term population-based cohort studies performed.

Objective To compare the incidence of cancer in patients receiving immune suppression after kidney transplantation with incidence in the same population in 2 periods before receipt of immune suppression: during dialysis and during end-stage kidney disease before renal replacement therapy (RRT).

Design, Setting, and Participants A population-based cohort study of 28 855 patients with end-stage kidney disease who received RRT, with 273 407 person-years of follow-up. Incident cancers (1982-2003) were ascertained by record linkage between the Australia and New Zealand Dialysis and Transplant Registry and the Australian National Cancer Statistics Clearing House.

Main Outcome Measure Standardized incidence ratios (SIRs) of cancer, using age-specific, sex-specific, calendar year–specific, and state/territory–specific population cancer incidence rates.

Results The overall incidence of cancer, excluding nonmelanoma skin cancer and those cancers known to frequently cause end-stage kidney disease, was markedly increased after transplantation (n = 1236; SIR, 3.27; 95% confidence interval [CI], 3.09-3.46). In contrast, cancer incidence was only slightly increased during dialysis (n = 870; SIR, 1.35; 95% CI, 1.27-1.45) and before RRT (n = 689; SIR, 1.16; 95% CI, 1.08-1.25). After transplantation, cancer occurred at significantly increased incidence at 25 sites, and risk exceeded 3-fold at 18 of these sites. Most of these cancers were of known or suspected viral etiology.

Conclusions Kidney transplantation is associated with a marked increase in cancer risk at a wide variety of sites. Because SIRs for most types of cancer were not increased before transplantation, immune suppression may be responsible for the increased risk. These data suggest a broader than previously appreciated role of the interaction between the immune system and common viral infections in the etiology of cancer.