IMMUNOSUPPRESSION agent exposure is linked to an increased incidence of primary malignant neoplasms in kidney transplant recipients, and this association varies by age and sex.
Kidney transplantation, the preferred treatment for end-stage kidney disease, requires the use of immunosuppression agents to prevent allograft rejection. However, this increases patient susceptibility to infections and cancers associated with oncogenic viruses (such as non-Hodgkin lymphomas) and oropharyngeal cancers (caused by human papillomavirus). Researchers aimed to quantify the increased risk of cancer in kidney transplant recipients, and investigate if the risk is affected by age and sex. skin
The research team investigated immunosuppression agent use and the prevalence of cancer over the 10 years in 1064 kidney transplant recipients, between January 1997 and December 2016. Main analyses focused on the associations between immunosuppression agent exposure and primary malignant neoplasm incidence. A total of 108 patients (10.2%) were diagnosed with primary malignant neoplasm over a median follow-up of 73 months. The analysis revealed that 19.4% of all primary cancer cases were in situ neoplasms, and cancers of the skin were the most frequent with an incidence rate of 886 per 100,000 person-years (95% confidence interval [CI]: 681–1134).
Cancer risk was higher in participants over 55 years (incidence rate [IR] = 2275 per 100,000 person-years; 95% CI: 1766–2884) than under 55 years (IR = 971 per 100,000 person-years; 95% CI: 694–1322). The results demonstrated that the risk of primary malignant neoplasm associated with cumulative tacrolimus exposure was modified by age (interaction p=.035) and was more pronounced in 15-year and 30-year-old participants (adjusted hazard ratios: 1.57 and 1.31 [1.03–1.66], respectively) in comparison to older KTR. Additionally, the increased risk of primary malignant neoplasm associated with higher cumulative mycophenolate dose was more pronounced in females than males (adjusted hazard ratio: 1.86 and 1.16, respectively).
In conclusion, long-term exposure to tacrolimus significantly increased the risk of primary malignant neoplasms in younger kidney transplant recipients. Whereas, higher cumulative doses of mycophenolate were associated with increased incidence of primary malignant neoplasms in females. The results of the study highlight the need for personalised immunosuppression protocols considering patient age and sex to optimize outcomes and mitigate cancer risk in kidney transplant recipients.
Katrina Thornber, EMJ
Reference
Sapir-Pichhadze R et al. Immunosuppression and cancer risk in kidney transplant recipients: A retrospective cohort study. Int J Cancer. 2024;154(12):2043-53.
