Mortality from cancer is not increased in elderly kidney transplant recipients compared to the general population: a com
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ORIGINAL ARTICLE
Mortality from cancer is not increased in elderly kidney transplant recipients compared to the general population: a competing risk analysis 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 Girolomoni1 Received: 5 April 2020 / Accepted: 18 August 2020 © Italian Society of Nephrology 2020
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. Keywords Renal transplant recipients · Causes of death · Competing risk analysis · Cancer-related mortality
Introduction Kidney transplant recipients have a higher incidence of some cancers, but whether this translates into an excess cancer-related mortality in all age categories is still a matter of debate. Some studies have described an overall risk of cancer death after kidney transplantation up to tenfold Gianpaolo Tessari and Umberto Maggiore contributed equally to the manuscript. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40620-020-00847-5) contains supplementary material, which is available to authorized users. * Gianpaolo Tessari [email protected] Extended author information available on the last page of the article
higher than in the general population [1–3], whereas more recent studies have shown that it is increased on average by 2.7 times [4]. In the few studies focussing on the mortality risk in different age categories,
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