Cancer Mortality among US Solid Organ Transplant Recipients: Novel Methodologies to Estimate Cancer Burden using Linked Population-Based Registries
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AbstractBackground: The solid organ transplant population has an elevated risk of cancer compared with the general population. Excess risk is largely due to immunosuppression. As this population grows, understanding long-term health risks such as cancer is critical. Population-based estimates of cancer mortality are needed since they measure the downstream outcome following a cancer diagnosis. Furthermore, quantifying deaths attributable to cancer can inform priorities to reduce the cancer burden. Methods: Linked transplant and cancer registry data were used to identify incident cancers and deaths among solid organ transplant recipients in the United States (1987-2014). Population-attributable fractions (PAFs) of deaths due to cancer and corresponding cancer-attributable mortality rates were estimated. Cancer-attributable mortality rates computed using the PAF were compared to cancer-specific mortality rates computing using cause of death (COD). The life-years lost (LYL) to cancer were estimated using two methods: an approach using matching to construct a cancer-free cohort and an approach using Cox proportional hazards regression models. Results: Among 221,962 transplant recipients, 15,012 developed cancer. Thirteen percent of deaths (PAF=13.2%) were attributable to cancer, corresponding to a cancer-attributable mortality rate of 516 per 100,000 person-years. Lung cancer was the largest contributor to mortality (PAF=3.1%), followed by non-Hodgkin lymphoma (NHL, PAF=1.9%), colorectal cancer (PAF=0.7%), and kidney cancer (PAF=0.5%). Overall, the cancer-specific mortality rate lower, 368 per 100,000 person-years. Within 10 years post-transplant, the mean LYL was 0.16 years per transplant recipient and 2.7 years per cancer. Cancer accounted for 1.9% of the total LYL expected in this population. Lung cancer was the largest contributor, accounting for 24% of all LYL, and NHL had the next highest contribution (15%). Conclusions: Cancer is a substantial cause of mortality among solid organ transplant recipients resulting in excess deaths and a shortened lifespan. Lung cancer and NHL are major contributors to the cancer burden including LYL to cancer, highlighting opportunities to reduce cancer mortality through prevention and screening.
DescriptionEpidemiology and Preventive Medicine
University of Maryland, Baltimore
Keywordlinked population-based registries
Registries--statistics & numerical data