Gianpaolo Tessari1, Umberto Maggiore2, Gianluigi Zaza3, Rostand Emmanuel Nguefouet Momo4, Francesco Nacchia4, Luigino Boschiero4, Silvio Sandrini5, Luigi Naldi6, Eliana Gotti7, Mariarosaria Campise8, Piergiorgio Messa8, Alessandra Palmisano2, Irene Capelli9, Enrico Minetti10, Michele Rossini11, Giampiero Girolomoni12. 1. Section of Dermatology, Dermatology Unit, Department of Medicine, University of Verona, Ospedale Civile Maggiore, Piazzale Stefani 1, 37126, Verona, VR, Italy. gianpaolo.tessari@aovr.veneto.it. 2. Nephrology Unit, Dipartimento di Medicina e Chirurgia, Università di Parma, Azienda-Ospedaliero Universitaria di Parma, Parma, Italy. 3. Nephrology Unit, Department of Medicine, University of Verona, Verona, Italy. 4. Kidney Transplantation Centre, Azienda Ospedaliero Universitaria Integrata, Verona, Italy. 5. Nephrology Unit, Azienda Ospedaliera Spedali Civili, Brescia, Italy. 6. Dermatology Unit, Ospedale San Bortolo, Azienda Ospedaliera Vicenza, Vicenza, Italy. 7. Nephrology Unit, Ospedali Riuniti, Bergamo, Italy. 8. Nephrology Unit, Ospedale Maggiore-Policlinico, MaRE, IRCCS, Milan, Italy. 9. Department of Nephrology, Dialysis and Renal Transplantation, S. Orsola University Hospital, Bologna, Italy. 10. Nephrology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. 11. Nephrology Unit, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, Italy. 12. Section of Dermatology, Dermatology Unit, Department of Medicine, University of Verona, Ospedale Civile Maggiore, Piazzale Stefani 1, 37126, Verona, VR, Italy.
Abstract
BACKGROUND: The impact of cancer on death of elderly kidney transplant recipients has been extensively investigated, but with conflicting results. Unlike their younger counterparts, in elderly kidney transplant recipients cardiovascular and infectious disease may outweigh cancer in causing the patient's death. METHODS: Using competing risk analysis on a large retrospective cohort of kidney transplant recipients, we estimated the cause-specific cumulative incidence and hazard of death in different age categories and calculated standardized mortality ratios (SMRs) to compare mortality rates with the general population. RESULTS: Six thousand seven hundred eighty-nine kidney transplant recipients were followed-up for a median of 9 years. Ten years after transplantation, in transplant recipients aged 20-39, 40-59, and 60+, the cumulative incidence of cancer-related death was 0.6 (95% confidence interval [CI]: 0.3-1.0), 2.9 (2.3-3.6) and 5.3% (3.5-7.5), whereas the SMR was 9.1 (5.5-15.0), 2.0 (1.6-2.5), and 0.8 (0.6-1.0), respectively. At variance with young recipients, the hazard and the cumulative incidence of cardiovascular-related death in elderly recipients was well above that of cancer-related death. CONCLUSIONS: Relative to the general population, cancer-related death is increased in young but not in elderly kidney transplant recipients because of the more marked increased incidence of competing cause of death in the latter category.
BACKGROUND: The impact of cancer on death of elderly kidney transplant recipients has been extensively investigated, but with conflicting results. Unlike their younger counterparts, in elderly kidney transplant recipients cardiovascular and infectious disease may outweigh cancer in causing the patient's death. METHODS: Using competing risk analysis on a large retrospective cohort of kidney transplant recipients, we estimated the cause-specific cumulative incidence and hazard of death in different age categories and calculated standardized mortality ratios (SMRs) to compare mortality rates with the general population. RESULTS: Six thousand seven hundred eighty-nine kidney transplant recipients were followed-up for a median of 9 years. Ten years after transplantation, in transplant recipients aged 20-39, 40-59, and 60+, the cumulative incidence of cancer-related death was 0.6 (95% confidence interval [CI]: 0.3-1.0), 2.9 (2.3-3.6) and 5.3% (3.5-7.5), whereas the SMR was 9.1 (5.5-15.0), 2.0 (1.6-2.5), and 0.8 (0.6-1.0), respectively. At variance with young recipients, the hazard and the cumulative incidence of cardiovascular-related death in elderly recipients was well above that of cancer-related death. CONCLUSIONS: Relative to the general population, cancer-related death is increased in young but not in elderly kidney transplant recipients because of the more marked increased incidence of competing cause of death in the latter category.
Authors: Anne-Michelle Noone; Ruth M Pfeiffer; Joanne F Dorgan; Laurence S Magder; Jonathan S Bromberg; Charles F Lynch; Cyllene R Morris; Karen S Pawlish; Eric A Engels Journal: Cancer Date: 2019-04-29 Impact factor: 6.921