Cancer risk and mortality after kidney transplantation

a population-based study on differences between Danish centres using standard immunosuppression with and without glucocorticoids

Henriette Engberg, Sonja Wehberg, Claus Bistrup, James Goya Heaf, Søren Schwartz Sørensen, Helle Charlotte Thiesson, Jesper Melchior Hansen, My Svensson, Anders Green, Peter Marckmann

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

BACKGROUND: Kidney recipients receive immunosuppression to prevent graft rejection, and long-term outcomes such as post-transplant cancer and mortality may vary according to the different protocols of immunosuppression.

METHODS: A national register-based historical cohort study was conducted to examine whether post-transplant cancer and all-cause mortality differed between Danish renal transplantation centres using standard immunosuppressive protocols including steroids (Centres 2, 3, 4) or a steroid-free protocol (Centre 1). The Danish Nephrology Registry, the Danish Civil Registration System, the Danish National Cancer Registry and the Danish National Patient Register were used. A historical cohort of 1450 kidney recipients transplanted in 1995-2005 was followed up with respect to post-transplant cancer and death until 31 December 2011.

RESULTS: Compared with Center 1 the adjusted post-transplant cancer risk was 6-39% lower in Centre 3 [hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.67-1.32], in Centre 2 (HR 0.72, 95% CI 0.52-0.98) and in Centre 4 (HR 0.61, 95% CI 0.44-0.83). Compared with Center 1, the adjusted post-transplant mortality was 21-55% higher in Centre 4 (HR 1.21, 95% CI 0.91-1.61), in Centre 3 (HR 1.35, 95% CI 0.98-1.86) and in Centre 2 (HR 1.55, 95% CI 1.17-2.05). On average, post-transplant cancer was associated with a 4-fold increase in the risk of death (HR 4.25, 95% CI 3.36-5.38).

CONCLUSIONS: There was a tendency of a higher post-transplant cancer occurrence, but lower all-cause mortality, in the Danish transplantation centre that adhered to a standard steroid-free immunosuppressive protocol.

OriginalsprogEngelsk
TidsskriftNephrology, Dialysis, Transplantation
Vol/bind31
Udgave nummer12
Sider (fra-til)2149-2156
ISSN0931-0509
DOI
StatusUdgivet - dec. 2016

Fingeraftryk

Kidney Transplantation
Glucocorticoids
Confidence Intervals
Population
Neoplasms
Immunosuppressive Agents
Registries
Kidney
Nephrology
Graft Rejection
Cohort Studies

Citer dette

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title = "Cancer risk and mortality after kidney transplantation: a population-based study on differences between Danish centres using standard immunosuppression with and without glucocorticoids",
abstract = "BACKGROUND: Kidney recipients receive immunosuppression to prevent graft rejection, and long-term outcomes such as post-transplant cancer and mortality may vary according to the different protocols of immunosuppression.METHODS: A national register-based historical cohort study was conducted to examine whether post-transplant cancer and all-cause mortality differed between Danish renal transplantation centres using standard immunosuppressive protocols including steroids (Centres 2, 3, 4) or a steroid-free protocol (Centre 1). The Danish Nephrology Registry, the Danish Civil Registration System, the Danish National Cancer Registry and the Danish National Patient Register were used. A historical cohort of 1450 kidney recipients transplanted in 1995-2005 was followed up with respect to post-transplant cancer and death until 31 December 2011.RESULTS: Compared with Center 1 the adjusted post-transplant cancer risk was 6-39{\%} lower in Centre 3 [hazard ratio (HR) 0.94, 95{\%} confidence interval (CI) 0.67-1.32], in Centre 2 (HR 0.72, 95{\%} CI 0.52-0.98) and in Centre 4 (HR 0.61, 95{\%} CI 0.44-0.83). Compared with Center 1, the adjusted post-transplant mortality was 21-55{\%} higher in Centre 4 (HR 1.21, 95{\%} CI 0.91-1.61), in Centre 3 (HR 1.35, 95{\%} CI 0.98-1.86) and in Centre 2 (HR 1.55, 95{\%} CI 1.17-2.05). On average, post-transplant cancer was associated with a 4-fold increase in the risk of death (HR 4.25, 95{\%} CI 3.36-5.38).CONCLUSIONS: There was a tendency of a higher post-transplant cancer occurrence, but lower all-cause mortality, in the Danish transplantation centre that adhered to a standard steroid-free immunosuppressive protocol.",
author = "Henriette Engberg and Sonja Wehberg and Claus Bistrup and Heaf, {James Goya} and S{\o}rensen, {S{\o}ren Schwartz} and Thiesson, {Helle Charlotte} and Hansen, {Jesper Melchior} and My Svensson and Anders Green and Peter Marckmann",
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year = "2016",
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doi = "10.1093/ndt/gfw304",
language = "English",
volume = "31",
pages = "2149--2156",
journal = "Nephrology, Dialysis, Transplantation",
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Cancer risk and mortality after kidney transplantation : a population-based study on differences between Danish centres using standard immunosuppression with and without glucocorticoids. / Engberg, Henriette; Wehberg, Sonja; Bistrup, Claus; Heaf, James Goya; Sørensen, Søren Schwartz; Thiesson, Helle Charlotte; Hansen, Jesper Melchior; Svensson, My; Green, Anders; Marckmann, Peter.

I: Nephrology, Dialysis, Transplantation, Bind 31, Nr. 12, 12.2016, s. 2149-2156.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Cancer risk and mortality after kidney transplantation

T2 - a population-based study on differences between Danish centres using standard immunosuppression with and without glucocorticoids

AU - Engberg, Henriette

AU - Wehberg, Sonja

AU - Bistrup, Claus

AU - Heaf, James Goya

AU - Sørensen, Søren Schwartz

AU - Thiesson, Helle Charlotte

AU - Hansen, Jesper Melchior

AU - Svensson, My

AU - Green, Anders

AU - Marckmann, Peter

N1 - © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

PY - 2016/12

Y1 - 2016/12

N2 - BACKGROUND: Kidney recipients receive immunosuppression to prevent graft rejection, and long-term outcomes such as post-transplant cancer and mortality may vary according to the different protocols of immunosuppression.METHODS: A national register-based historical cohort study was conducted to examine whether post-transplant cancer and all-cause mortality differed between Danish renal transplantation centres using standard immunosuppressive protocols including steroids (Centres 2, 3, 4) or a steroid-free protocol (Centre 1). The Danish Nephrology Registry, the Danish Civil Registration System, the Danish National Cancer Registry and the Danish National Patient Register were used. A historical cohort of 1450 kidney recipients transplanted in 1995-2005 was followed up with respect to post-transplant cancer and death until 31 December 2011.RESULTS: Compared with Center 1 the adjusted post-transplant cancer risk was 6-39% lower in Centre 3 [hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.67-1.32], in Centre 2 (HR 0.72, 95% CI 0.52-0.98) and in Centre 4 (HR 0.61, 95% CI 0.44-0.83). Compared with Center 1, the adjusted post-transplant mortality was 21-55% higher in Centre 4 (HR 1.21, 95% CI 0.91-1.61), in Centre 3 (HR 1.35, 95% CI 0.98-1.86) and in Centre 2 (HR 1.55, 95% CI 1.17-2.05). On average, post-transplant cancer was associated with a 4-fold increase in the risk of death (HR 4.25, 95% CI 3.36-5.38).CONCLUSIONS: There was a tendency of a higher post-transplant cancer occurrence, but lower all-cause mortality, in the Danish transplantation centre that adhered to a standard steroid-free immunosuppressive protocol.

AB - BACKGROUND: Kidney recipients receive immunosuppression to prevent graft rejection, and long-term outcomes such as post-transplant cancer and mortality may vary according to the different protocols of immunosuppression.METHODS: A national register-based historical cohort study was conducted to examine whether post-transplant cancer and all-cause mortality differed between Danish renal transplantation centres using standard immunosuppressive protocols including steroids (Centres 2, 3, 4) or a steroid-free protocol (Centre 1). The Danish Nephrology Registry, the Danish Civil Registration System, the Danish National Cancer Registry and the Danish National Patient Register were used. A historical cohort of 1450 kidney recipients transplanted in 1995-2005 was followed up with respect to post-transplant cancer and death until 31 December 2011.RESULTS: Compared with Center 1 the adjusted post-transplant cancer risk was 6-39% lower in Centre 3 [hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.67-1.32], in Centre 2 (HR 0.72, 95% CI 0.52-0.98) and in Centre 4 (HR 0.61, 95% CI 0.44-0.83). Compared with Center 1, the adjusted post-transplant mortality was 21-55% higher in Centre 4 (HR 1.21, 95% CI 0.91-1.61), in Centre 3 (HR 1.35, 95% CI 0.98-1.86) and in Centre 2 (HR 1.55, 95% CI 1.17-2.05). On average, post-transplant cancer was associated with a 4-fold increase in the risk of death (HR 4.25, 95% CI 3.36-5.38).CONCLUSIONS: There was a tendency of a higher post-transplant cancer occurrence, but lower all-cause mortality, in the Danish transplantation centre that adhered to a standard steroid-free immunosuppressive protocol.

U2 - 10.1093/ndt/gfw304

DO - 10.1093/ndt/gfw304

M3 - Journal article

VL - 31

SP - 2149

EP - 2156

JO - Nephrology, Dialysis, Transplantation

JF - Nephrology, Dialysis, Transplantation

SN - 0931-0509

IS - 12

ER -