Excess risk of cancer in renal transplant patients

Cancer data were reviewed in 488 patients who underwent renal transplantation and received cyclosporine at our centre from January 1985 to December 1995. Incidence of nonmelanoma skin cancer (NMSC) was standardized on the age and sex distribution of the French population. For cancer other than NMSC, we calculated the ratio of observed to expected numbers of cancer cases in the RT population, based on age- and sex-specific incidence for cancer in France. Standardized incidence ratios (SIR) were calculated for all cancers and for specific cancer types encountered. Over 4,638 patient-years of exposure, 51 (10.4%) transplant recipients developed a first NMSC which was significantly associated with older age at transplantation (P < 0.0001) and the 1991-1995 transplantation period (P = 0.0008). Fifty-six recipients developed cancer other than NMSC over the period. The SIR for all cancer was 2.2 (1.5-3.0) in males and 3.0 (1.9-4.6) in females. The SIR for specific cancer types revealed significant excess for native kidneys [13.0 (5.2-26.8)] prostate cancer [3.6 (1.5-3.0)] and post-transplant lymphoproliferative disorder (PTLD) [9.5 (3.1-22.1)] in males, and cervical cancer [25.3 (9.3-55.0)], native kidneys [26.4 (5.4-77.2)] and PTLD [28.9 (9.4-67.6)] in females. Incidence of NMSC and some types of other cancer is high in cyclosporine-treated patients. Optimizing monitoring practice might be useful to identify subjects with significant excess risk for specific types of solid tumours.