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KMID : 0191120200350200166
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Journal of Korean Medical Science
2020 Volume.35 No. 20 p.166 ~ p.166
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Risk of Graft Failure in Kidney Recipients with Cured Post-Transplant Cancer
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Kim Ji-Eun
Min Sang-Il
Lee Ha-Jeong
Ha Jong-Won
Kim Yon-Su
Han Seung-Seok
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Abstract
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Background: Post-transplant cancer (PTC) is a critical complication after kidney transplantation. However, whether successfully cured PTC affects the long-term graft outcome remains unclear.
Methods: We retrospectively reviewed 1,629 kidney transplant recipients from 1995 to 2017 after excluding patients with post-transplant hematologic or advanced non-curable cancers and who underwent allograft nephrectomy because of cancer. Cured PTCs were defined as cancers treated with curative methods and/or adjuvant therapy without recurrence during ≥ 2 years. Propensity score matching was performed to match cured PTC patients with cancer-naive patients (i.e., non-PTC group).
Results: During the median period of 7 years (maximum, 23 years), 70 patients (4.3%) had cured PTCs. The PTC group showed significantly higher risks of death-censored graft failure (adjusted hazard ratio [HR], 2.56 [1.05?6.23]), class II donor-specific antibodies (adjusted HRs, 3.37 [1.30?8.71]), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (adjusted HR, 2.68 [1.43?5.02]) and random urine protein/creatinine ratio > 1 g (adjusted HR, 3.61 [1.92?6.79]) compared to non-PTC group. However, the risk of mortality was not different between the PTC and non-PTC groups. According to the cancer type, only urogenital cancer had a significant association with graft failure (adjusted HR, 4.26 [1.19?15.22]) and the gastrointestinal cancer showed elevated risk of T cell mediated rejection compared to non-PTC (adjusted HR, 20.44 [6.02?69.39]).
Conclusion: Appropriate monitoring of graft function is necessary in patients with cured PTCs.
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KEYWORD
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Cancer, Kidney Transplantation, Graft Function, Malignancy, Mortality
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