Solid organ transplantation in cancer survivors is associated with reduced overall survival (OS) but not cancer-specific survival, according to results of a study published in Cancer Epidemiology, Biomarkers, and Prevention.
It hasn’t been clear if transplant-related immunosuppression increases the risk of relapse or death among cancer patients, the study authors noted.
To gain some insight, the authors used linked cancer registry data and transplant registry data to assess survival in cancer survivors who received an organ transplant.
The data encompassed more than 10.5 million patients with 27 cancer types. A total of 5425 patients underwent solid organ transplant after their cancer diagnosis.
In a matched analysis, transplant was associated with reduced OS for most cancer types. The highest adjusted hazard ratios (aHRs) for overall mortality were observed for cancers of the cervix (aHR, 3.52; 95% CI, 2.30-5.38), ovary (aHR, 3.71; 95% CI, 2.09-6.56), testis (aHR, 4.38; 95% CI, 2.48-7.74), and thyroid (aHR, 4.23; 95% CI, 3.24-5.52).
Myeloma was the only cancer for which solid organ transplant was not associated with reduced OS (aHR, 0.89; 95% CI, 0.66-1.21).
The study authors suggested that the associations between transplant and reduced OS are “likely due to end-stage organ disease and transplant-related complications.”
On the other hand, the data did not show associations between transplant and reduced cancer-specific survival, and the authors theorized that this may reflect “careful candidate selection.”
For most cancer types, cancer-specific mortality was not associated with solid organ transplant. However, the matched analysis showed an inverse association between transplant and cancer-specific mortality for breast cancer (aHR, 0.53; 95% CI, 0.33-0.86), non-Hodgkin lymphoma (aHR, 0.73; 95% CI, 0.40-1.31), and myeloma (aHR, 0.33; 95% CI, 0.17-0.64).
“These results do not demonstrate a detrimental effect of immunosuppression on cancer-specific survival and support current management strategies for transplant candidates with previous cancer diagnosis,” the study authors wrote.
Engels EA, Haber G, Hart A, et al. Solid organ transplantation and survival among individuals with a history of cancer. Cancer Epidemiol Biomark Prev. 2021;30(7):1312-1319. doi: 10.1158/1055-9965.EPI-21-0044