Spectrum of cancer risk in Asian American and Pacific Islander solid organ transplant recipients

Solid organ transplant recipients (SOTRs) have increased cancer risk, which may differ across racial groups. Cancer risk among Asian American and Pacific Islander SOTRs is ill-defined.

We evaluated Asian, Pacific Islander, and White SOTRs from a linkage of the United States SOTR registry with 34 cancer registries (1990-2019). We calculated age- and sex-adjusted incidence rate ratios (aIRRs) to compare cancer risk between races and standardized incidence ratios (SIRs) to measure risk relative to race-matched general populations.

Compared with Asian SOTRs, Pacific Islander SOTRs had notably higher incidence of pancreatic cancer (aIRR = 3.7, 95% confidence interval [CI] = 1.6 to 8.6) and melanoma (aIRR = 6.7, 95% CI = 1.2 to 36). Compared with White SOTRs, Asian and Pacific Islander SOTRs had lower melanoma incidence but higher nasopharyngeal carcinoma incidence. Compared with the general population, Asian SOTRs had increased risk of cancers of the anus (SIR = 7.9, 95% CI = 3.6 to 15), penis (SIR = 8.9, 95% CI = 2.9 to 21), non-epithelial skin (SIR = 9.8, 95% CI = 5.4 to 17), kidney (SIR = 5.3, 95% CI = 4.3 to 6.5), and renal pelvis (SIR = 7.4, 95% CI = 3.7 to 13); non-Hodgkin lymphoma including chronic lymphocytic leukemia (NHL/CLL) (SIR = 6.4, 95% CI = 5.6 to 7.3); Hodgkin lymphoma (SIR = 6.1, 95% CI = 2.8 to 12); and Kaposi sarcoma (SIR = 15, 95% CI = 6.6 to 30). Compared with the general population, Pacific Islander SOTRs had increased risk of cancers of the anus (SIR = 12, 95% CI = 1.5 to 45), pancreas (SIR = 3.3, 95% CI = 1.3 to 6.8), non-epithelial skin (SIR = 9.3, 95% CI = 1.1 to 34), and thyroid (SIR = 3.4, 95% CI = 1.2 to 7.4); NHL/CLL (SIR = 4.5, 95% CI = 2.3 to 7.9); and Kaposi sarcoma (SIR = 71, 95% CI = 8.6 to 258).

Asian, Pacific Islander, and White SOTRs all experienced elevated cancer risk compared with their race-matched general population. Different cancer risks in these racial groups might be explained by differences in risk factors in the general population or unique features of SOTRs in these groups.