Solid Organ Malignancy After Pancreas Transplantation: A Four Decade Single-Center Experience

Area of Science:

• Transplantation Medicine
• Oncology
• Immunosuppression

Background:

• Pancreas transplantation advances improve survival but increase malignancy risk due to prolonged immunosuppression.
• Solid organ malignancies are a serious concern in long-term transplant survivors.

Purpose of the Study:

• To investigate the incidence, risk factors, and outcomes of solid organ malignancies in pancreas transplant recipients.
• To identify specific cancers and associated risk factors in this patient population.

Main Methods:

• Retrospective review of adult pancreas transplants (pancreas transplant alone, simultaneous pancreas-kidney, pancreas after kidney) from 1983-2023.
• Analysis of 1729 recipients with a median follow-up of 23 years.

Main Results:

• 152 recipients (8.8%) developed malignancies, with a 30-year cumulative incidence of 13%.
• Common cancers included colorectal, renal cell, breast, and lung. Risk factors identified were corticosteroid use and transplant era.
• Overall survival post-malignancy diagnosis was poor (10-year survival 24%).

Conclusions:

• Solid organ malignancies are a substantial late complication in pancreas transplant recipients.
• Corticosteroid exposure and graft longevity are key risk factors.
• Long-term cancer surveillance and tailored immunosuppression are essential for this population.