Solid Organ Transplantation in Patients with Preexisting Malignancies in Remission: A Propensity Score Matched Cohort Study

Background Solid organ transplant recipients (SOTR) with pretransplant malignancies (PTM) have worse overall survival (OS) compared to recipients without history of malignancy. However, it is unknown whether the increased risk of mortality is due to recurrent cancer-related deaths. Methods All SOTR in Ontario between 1991 and 2010 were identified and matched 1:2 to recipients without PTM using a propensity score. OS was compared using the Kaplan-Meier estimator and Cox proportional hazard models. For cancer-specific mortality and cancer recurrence, cause-specific hazard models were used and the cumulative incidence was plotted. Results Recipients with PTM had a worse OS compared to recipients without PTM (median OS: 10.3 versus 13.4 years). Recipients with PTM were not only at increased risk of cancer-specific mortality (CSHR:1.85 [95%CI: 1.20, 2.86]) but also at increased risk of noncancer death (CSHR:1.29 [95%CI: 1.08, 1.54]). Compared to recipients without PTM, recipients with high-risk PTM had higher all-cause mortality (HR:1.81 [95%CI: 1.47, 2.23]). Recipients with low-risk PTM were not at increased risk (HR:1.06 [95%CI: 0.86, 1.31]). Conclusion Recipients with PTM are at increased risk of all-cause mortality compared to recipients without PTM. This increased risk was noted for both cancer-specific and noncancer mortality. However, only those with high-risk PTM had worse outcomes. Corresponding Author: Dr. Nancy Baxter, MD, PhD, Division of General Surgery, St. Michael's Hospital, 040-16 Cardinal Carter Wing, 30 Bond Street, Toronto, ON, M5B 1W8 Canada | BaxterN@smh.ca Funding source: This study was funded by a Canadian Institutes of Health Research (CIHR) Operating Grant (Funding Reference No. 115164) and CIHR Foundation Grant (Funding Reference No. 148470). The funding sources had no role in the design or conduct of the study; collection, management, analysis or interpretation of the data; or preparation, review or approval of the manuscript. Disclaimers: There are no conflicts of interest to disclose. This work was presented as an oral presentation (Abstract number: 822) at the 2016 American Transplant Congress, Boston, MA, June 11-25, 2016. Authorship: Sergio A. Acuna, hypothesis generation and study design, data acquisition, statistical analysis, interpretation of findings, writing of the manuscript, and approval of the final draft. Rinku Sutradhar, study design, interpretation of findings, and approval of the final draft. S. Joseph Kim, study design, interpretation of findings, and approval of the final draft. Nancy N. Baxter, hypothesis generation and research design, interpretation of findings, writing of the manuscript, and approval of the final draft. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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