Solid organ transplantation and survival among individuals with a history of cancer
Menée aux Etats-Unis à partir de données de registres (registres des cancers et registre des greffes) portant sur 10 524 326 patients ayant des antécédents de cancer (17 types de cancer), cette étude analyse l'association entre une greffe d'organe et la survie globale
Résumé en anglais
Background: The success of immunotherapy highlights a possible role for immunity in controlling cancer during remission for cancer patients in the general population. A prior cancer diagnosis is common among solid organ transplant candidates, and immunosuppressive medications administered to transplant recipients may increase recurrence risk.
Methods: Using linked data from the United States solid organ transplant registry and 13 cancer registries, we compared overall and cancer-specific survival among cancer patients who did vs. did not receive subsequent transplantation. We used Cox regression in cohort and matched analyses, controlling for demographic factors, cancer stage, and time since cancer diagnosis.
Results: The study included 10,524,326 cancer patients with 17 cancer types; 5425 (0.05%) subsequently underwent solid organ transplantation. The median time from cancer diagnosis to transplantation was 4.17 years. Transplantation was associated with reduced overall survival for most cancers, especially cervical, testicular, and thyroid cancers (adjusted hazard ratios [aHRs] for overall mortality: 3.43-4.88). In contrast, transplantation was not associated with decreased cancer-specific survival for any cancer site, and we observed inverse associations for patients with breast cancer (aHRs for cancer-specific mortality: 0.65-0.67), non-Hodgkin lymphoma (0.50-0.51), and myeloma (0.39-0.42).
Conclusions: Among US cancer patients, subsequent organ transplantation was associated with reduced overall survival, likely due to end-stage organ disease and transplant-related complications. However, we did not observe adverse associations with cancer-specific survival, partly reflecting careful candidate selection.
Impact: 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 diagnoses.
