De novo cancer-related mortality after solid organ transplantation in England: the EpCOT study

Cancer is a major cause of mortality after solid organ transplantation (SOT). Quantifying this risk is difficult due to heterogeneous reports and methodological limitations.

We conducted a population-based cohort study linking data between the UK Transplant Registry, National Cancer Registry, Civil Registration of Deaths, and Hospital Episode Statistics for all SOT recipients in England between 1st June 1992 and 31st December 2015.

Among 50,762 SOT recipients, 22,361 deaths were recorded, of which 3550 (15.9%) were due to cancer, making it the second leading cause of mortality. Overall cancer (excluding non-melanomatous skin cancer) standardised mortality ratio (SMR) was 2.12 (95% CI: 2.05-2.19). Cancer mortality was highest among lung recipients (SMR 3.49; 95% CI: 2.96-4.06), and lowest in kidney recipients (SMR 2.00; 95% CI: 1.92-2.08). Non-Hodgkin's Lymphoma had highest mortality after SOT (SMR 9.86; 95% CI: 9.01-10.75) and was elevated across all transplant types. However, liver and kidney cancer mortality was disproportionately elevated among liver (SMR: 9.30; 95% CI: 7.53-11.24) and kidney transplant recipients (SMR: 5.11; 95% CI: 4.34-5.93), respectively. Several cancers showed no increased mortality.

De novo cancer remains a major cause of long-term mortality after SOT in England, with risk stratified by cancer and/or allograft.