Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/35694
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Type: Journal article
Title: Cancer incidence before and after kidney transplantation
Author: Vajdic, C.
McDonald, S.
McCredie, M.
van Leeuwen, M.
Stewart, J.
Law, M.
Chapman, J.
Webster, A.
Kaldor, J.
Grulich, A.
Citation: JAMA: Journal of the American Medical Association, 2006; 296(23):2823-2831
Publisher: Amer Medical Assoc
Issue Date: 2006
ISSN: 0098-7484
1538-3598
Statement of
Responsibility: 
Claire M. Vajdic, Stephen P. McDonald, Margaret R. E. McCredie, Marina T. van Leeuwen, John H. Stewart, Matthew Law, Jeremy R. Chapman Angela C. Webster,John M. Kaldor, Andrew E. Grulich
Abstract: 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.
Keywords: Humans
Virus Diseases
Neoplasms
Kidney Failure, Chronic
Immunosuppression
Renal Replacement Therapy
Kidney Transplantation
Registries
Incidence
Risk
Cohort Studies
Adolescent
Adult
Aged
Middle Aged
Child
Australia
New Zealand
Female
Male
Rights: © American Medical Association. All Rights Reserved.
DOI: 10.1001/jama.296.23.2823
Appears in Collections:Aurora harvest
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