Kidney recipients receive immunosuppression to prevent graft rejection, and long-term outcomes such as post-transplant cancer and mortality may vary according to the different protocols of immunosuppression.
A national register-based historical cohort study was conducted to examine whether post-transplant cancer and all-cause mortality differed between Danish renal transplantation centres using standard immunosuppressive protocols including steroids (Centres 2, 3, 4) or a steroid-free protocol (Centre 1). The Danish Nephrology Registry, the Danish Civil Registration System, the Danish National Cancer Registry and the Danish National Patient Register were used. A historical cohort of 1450 kidney recipients transplanted in 1995-2005 was followed up with respect to post-transplant cancer and death until 31 December 2011.
Compared with Center 1 the adjusted post-transplant cancer risk was 6-39% lower than that in Centre 3 [hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.67-1.32], in Centre 2 (HR 0.72, 95% CI 0.52-0.98) and in Centre 4 (HR 0.61, 95% CI 0.44-0.83). Compared with Center 1, the adjusted post-transplant mortality was 21-55% higher than that in Centre 4 (HR 1.21, 95% CI 0.91-1.61), in Centre 3 (HR 1.35, 95% CI 0.98-1.86) and in Centre 2 (HR 1.55, 95% CI 1.17-2.05). On average, post-transplant cancer was associated with a 4-fold increase in the risk of death (HR 4.25, 95% CI 3.36-5.38).
There was a tendency of a higher post-transplant cancer occurrence, but lower all-cause mortality, in the Danish transplantation centre that adhered to a standard steroid-free immunosuppressive protocol.
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2016 Sep 01 [Epub ahead of print]
Henriette Engberg, Sonja Wehberg, Claus Bistrup, James Heaf, Søren Schwartz Sørensen, Helle Charlotte Thiesson, Jesper Melchior Hansen, My Svensson, Anders Green, Peter Marckmann
Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense Denmark Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark., Department of Nephrology, Odense University Hospital, Odense, Denmark., Department of Medicine, Zealand University Hospital, Roskilde, Denmark., Department of Nephrology, Copenhagen University Hospital, Copenhagen, Denmark., Department of Nephrology, Herlev Hospital, Herlev, Denmark., Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark., OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark OPEN, Odense Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.