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

被引:42
作者
Acuna, Sergio A. [1 ,2 ,3 ,4 ,5 ]
Sutradhar, Rinku [1 ,5 ]
Kim, S. Joseph [1 ,5 ,6 ,7 ,8 ]
Baxter, Nancy N. [1 ,2 ,3 ,4 ,5 ]
机构
[1] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada
[2] St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada
[3] St Michaels Hosp, Dept Surg, Toronto, ON, Canada
[4] Univ Toronto, Div Gen Surg, Dept Surg, Toronto, ON, Canada
[5] Inst Clin Evaluat Sci, Toronto, ON, Canada
[6] Univ Hlth Network, Toronto Gen Hosp, Div Nephrol, Toronto, ON, Canada
[7] Univ Hlth Network, Toronto Gen Hosp, Kidney Transplant Program, Toronto, ON, Canada
[8] Univ Toronto, Dept Med, Toronto, ON, Canada
基金
加拿大健康研究院;
关键词
CANCER INCIDENCE; RECIPIENTS; OUTCOMES; HEART; SURVIVAL; PRETRANSPLANTATION; GUIDELINES; LUNG;
D O I
10.1097/TP.0000000000002178
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background Solid-organ transplant recipients 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 solid-organ transplant recipients 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 with recipients without PTM (median OS, 10.3 years vs 13.4 years). Recipients with PTM were not only at increased risk of cancer-specific mortality (cause-specific hazard ratio, 1.85; 95% confidence interval [CI], 1.20-2.86) but also at increased risk of noncancer death (cause-specific hazard ratio, 1.29; 95% CI, 1.08-1.54). Compared with recipients without PTM, recipients with high-risk PTM had higher all-cause mortality (hazard ratio, 1.81; 95% CI, 1.47-2.23). Recipients with low-risk PTM were not at increased risk (hazard ratio, 1.06; 95% CI, 0.86-1.31). Conclusions 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.
引用
收藏
页码:1156 / 1164
页数:9
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