Risk of de novo cancers after transplantation: Results from a cohort of 7217 kidney transplant recipients, Italy 1997-2009

none65To assess incidence and risk factors for de novo cancers (DNCs) after kidney transplant (KT), we carried out a cohort investigation in 15 Italian KT centres. Seven thousand two-hundred seventeen KT recipients (64.2% men), transplanted between 1997 and 2007 and followed-up until 2009, represented the study group. Person years (PY) were computed from 30days after transplant to cancer diagnosis, death, return to dialysis or to study closure. The number of observed DNCs was compared to that expected in the general population of Italy through standardised incidence ratios (SIR) and 95% confidence intervals (CI). To identify risk factors, incidence rate ratios (IRR) were computed. Three-hundred ninety five DNCs were diagnosed during 39.598PYs, with Kaposi's sarcoma (KS), post-transplant lymphoproliferative disorders (PTLD), particularly non-Hodgkin' lymphoma (NHL), lung, kidney and prostate as the most common types. The overall IR was 9.98/1.000PY, with a 1.7-fold augmented SIR (95% CI: 1.6-1.9). SIRs were particularly elevated for KS (135), lip (9.4), kidney carcinoma (4.9), NHL (4.5) and mesothelioma (4.2). KT recipients born in Southern Italy were at reduced risk of kidney cancer and solid tumors, though at a higher KS risk, than those born in Northern Italy. Use of mTOR inhibitors (mTORi) exerted, for all cancers combined, a 46% significantly reduced risk (95% CI: 0.4-0.7). Our study findings confirmed, in Italy, the increased risks for cancer following KT, and they also suggested a possible protective effect of mTORi in reducing the frequency of post transplant cancers.mixedPiselli P; Serraino D; Segoloni GP; Sandrini S; Piredda GB; Scolari M; Rigotti P; Busnach G; Messa P; Donati D; Schena FP; Maresca MC; Tisone G; Veroux M; Sparacino V; Pisani F; Citterio F; The Immunosuppression and Cancer Study Group (2013) [Other members of the Immunosuppression and Cancer Study Group: Antonio Famulari; Federica Delreno; Giuseppe Grandaliano; Marco Fiorentino; Sergio Stefoni; Paola Todeschini; Laura Panicali; Chiara Valentini; Francesca Valerio; Nicola Bossini; Gisella Setti; Maria Benigna Michittu; Maria Gavina Murgia; Bruno Onano; Pierfrancesco Veroux; Giuseppe Giuffrida; Alessia Giaquinta; Domenico Zerbo; Laura Di Leo; Maria Luisa Perrino; Valeriana Colombo; Maria Chiara Sghirlanzoni; Antonio Leoni; Barbara Buscemi; Manuela Lazzarin; Stefano Zanini; Gionata Spagnoletti; Maria Paola Salerno; Evaldo Favi; Linda De Luca; Antonio Lavacca; Carmelo Cascone; Bice Virgilio; Fiorella Dossi; Andrea Fontanella; Andrea Ambrosini; Marco Di Cicco; Giuseppe Maria Ettorre; Lucia Miglioresi; Claudia Cimaglia; Alessandro Agresta; Vincenzo Puro; Giuseppe Ippolito; Lucia Fratino; Luigino Dal Maso; Paolo De Paoli]Piselli P; Serraino D; Segoloni GP; Sandrini S; Piredda GB; Scolari M; Rigotti P; Busnach G; Messa P; Donati D; Schena FP; Maresca MC; Tisone G; Veroux M; Sparacino V; Pisani F; Citterio F; The Immunosuppression and Cancer Study Group (2013) [Other members of the Immunosuppression and Cancer Study Group: Antonio Famulari; Federica Delreno; Giuseppe Grandaliano; Marco Fiorentino; Sergio Stefoni; Paola Todeschini; Laura Panicali; Chiara Valentini; Francesca Valerio; Nicola Bossini; Gisella Setti; Maria Benigna Michittu; Maria Gavina Murgia; Bruno Onano; Pierfrancesco Veroux; Giuseppe Giuffrida; Alessia Giaquinta; Domenico Zerbo; Laura Di Leo; Maria Luisa Perrino; Valeriana Colombo; Maria Chiara Sghirlanzoni; Antonio Leoni; Barbara Buscemi; Manuela Lazzarin; Stefano Zanini; Gionata Spagnoletti; Maria Paola Salerno; Evaldo Favi; Linda De Luca; Antonio Lavacca; Carmelo Cascone; Bice Virgilio; Fiorella Dossi; Andrea Fontanella; Andrea Ambrosini; Marco Di Cicco; Giuseppe Maria Ettorre; Lucia Miglioresi; Claudia Cimaglia; Alessandro Agresta; Vincenzo Puro; Giuseppe Ippolito; Lucia Fratino; Luigino Dal Maso; Paolo De Paoli