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Abstract Background and Aims Post-transplant malignancy has a negative effect on morbidity and mortality of kidney transplant recipients (KTR). Pre-transplant exposure to immunosuppression (PTI) might increase the risk for post-transplant malignancy. Method In a single-center, retrospective study of 3874 KTR transplanted between January 2000 and December 2019 with follow-up until 2020 the cancer incidence and outcome were compared between KTR with glomerulonephritis as primary kidney disease treated with PTI (GN group) and KTR with polycystic kidney disease as non-PTI-receiving controls (PKD group). Results In both groups, the average time from transplantation to cancer manifestation was similar (p=0.947) as well as from cancer diagnosis to death (p=0.856). Depending on cancer type we observed no difference between time of onset (p=0.351) but in incidence rate for death. The worst survival probability was in lung (0.041 years, 95% confidence interval (CI) 0.014-0.301) and gastrointestinal (0.350 years, 95% CI 0.022-1.558) cancer. The risk of cancer increased with age (hazard ratio (HR)=1.05, 95% CI 1.03, 1.07, p0.001). After adjustment, GN increased the risk for post-transplant cancer (HR=1.72, 95% CI 1.12, 2.63, p=0.013). PTI exposure had adjusted increase of risk of cancer (HR=1.76, 95% CI 1.07, 2.89, p=0.027). Posttransplant malignancy was associated with higher risk of death (HR=8.29, 95% CI 5.46, 12.59, p0.001) together with patient's age at the time of transplant surgery (HR=1.09, 95% CI 1.06, 1.11, p0.001) while neither gender (p=0.633) nor PTI (=0.0639). Patient's adjusted probability of remaining cancer-free posttransplant had decreasing tendency over time. Conclusion Patients with GN exposed to PTI showed higher adjusted risk of development of post-transplant malignancy.
Bloudíčková et al. (Wed,) studied this question.