Frontiers in Oncology (Jun 2023)
Multicenter analysis of immunosuppressive medications on the risk of malignancy following adult solid organ transplantation
Abstract
ObjectiveThis study aimed to assess the risk of maintenance immunosuppression on the post-transplant risk of malignancy across all solid organ transplant types.MethodsThis is a retrospective cohort study from a multicenter hospital system in the United States. The electronic health record was queried from 2000 to 2021 for cases of solid organ transplant, immunosuppressive medications, and post-transplant malignancy.ResultsA total of 5,591 patients, 6,142 transplanted organs, and 517 post-transplant malignancies were identified. Skin cancer was the most common type of malignancy at 52.8%, whereas liver cancer was the first malignancy to present at a median time of 351 days post-transplant. Heart and lung transplant recipients had the highest rate of malignancy, but this finding was not significant upon adjusting for immunosuppressive medications (heart HR 0.96, 95% CI 0.72 – 1.3, p = 0.88; lung HR 1.01, 95% CI 0.77 – 1.33, p = 0.94). Random forest variable importance calculations and time-dependent multivariate cox proportional hazard analysis identified an increased risk of cancer in patients receiving immunosuppressive therapy with sirolimus (HR 1.41, 95% CI 1.05 – 1.9, p = 0.04), azathioprine (HR 2.1, 95% CI 1.58 – 2.79, p < 0.001), and cyclosporine (HR 1.59, 95% CI 1.17 – 2.17, p = 0.007), while tacrolimus (HR 0.59, 95% CI 0.44 – 0.81, p < 0.001) was associated with low rates of post-transplant neoplasia.ConclusionOur results show varying risks of immunosuppressive medications associated with the development of post-transplant malignancy, demonstrating the importance of cancer detection and surveillance strategies in solid organ transplant recipients.
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