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

Background Although advances in pancreas transplantation have improved patient survival, prolonged immunosuppression has increased the risk of post‐transplant malignancies. This study aimed to examine the incidence, risk factors, and long‐term outcomes of solid organ malignancies in pancreas transplant recipients at a single center. Methods All adult pancreas transplants between February 1, 1983, and December 31, 2023 at the University of Minnesota were reviewed, including pancreas transplant alone (PTA), simultaneous pancreas‐kidney transplants (SPK), and pancreas after kidney transplants (PAK). Results 1729 pancreas transplant recipients were included with a median follow‐up of 23 years. During this period, 152 (8.8%) developed a non‐skin, non‐hematologic malignancy at a median time of 12.6 years after transplant, with a cumulative incidence of 13% (95% CI 11%–16%) at 30 years post‐transplant. The most common malignancies were colorectal (14.1%), renal cell (13.0%), breast (13.0%), and lung (9.7%) cancers. Functioning graft status (HR 0.67, 95% CI 0.47–0.95, p = 0.024), maintenance corticosteroid use (HR 1.51, 95% CI 1.00–2.27, p = 0.051), and transplant era ( p = 0.015) were risk factors for development of a solid organ malignancy. Overall survival following malignancy diagnosis was poor, with a 10‐year post‐diagnosis survival rate of 24% (95% CI 17%–33%). No recipient or transplant‐related factors were independently associated with mortality after malignancy diagnosis. Conclusion Solid organ malignancies constitute a substantial late complication in pancreas transplant recipients, with corticosteroid exposure and graft longevity as key risk factors. These findings underscore the need for long‐term cancer surveillance and tailored immunosuppressive strategies in this population.