Life-years gained and cancer burden in kidney transplantation compared with dialysis: insights from a nationwide dialysis-based cohort

Kidney transplant (KT) recipients require lifelong immunosuppression, whereas dialysis patients experience uremia-related immune dysfunction, both of which increase cancer risk. However, direct comparisons of cancer burden between these populations remain limited. We analyzed Taiwan’s National Health Insurance Research Database (1998–2022), including 9,378 KT recipients and 229,278 dialysis patients. Cancer incidence and mortality were identified through national cancer and death registries. During median follow-up periods of 9.6 years for cancer incidence and 11.1 years for mortality, kidney transplant recipients had a substantially lower all-cause mortality rate than dialysis patients (SMR, 0.39; 95% CI, 0.37–0.40), with an estimated survival advantage of 8–11 years. However, KT recipients had modestly higher cancer incidence (SIR = 1.10, 95% CI 1.05–1.15) and cancer-specific mortality (SMR = 1.12, 95% CI 1.04–1.20). Elevated risks were particularly observed for skin, kidney, bladder, and prostate cancers, as well as non-Hodgkin’s lymphoma. Overall, kidney transplantation was associated with substantially better survival than dialysis, despite a modestly higher long-term cancer risk. These findings support continued, risk-adapted cancer surveillance and prevention strategies for kidney transplant recipients.