International Urology and Nephrology

, Volume 46, Issue 4, pp 833–838

Epidemiology of post-transplant malignancy in Asian renal transplant recipients: a population-based study

Nephrology - Original Paper



Using Taiwan’s National Health Insurance Research Database, this large population-based study was conducted to explore the incidences and risk factors of post-transplant malignancy in Asian renal transplant recipients.

Patients and methods

A total of 642 patients who firstly underwent renal transplant between January 1, 2000 and December 31, 2008 were identified from a 2 million cohort. The primary endpoint was a subsequent hospitalization with a primary diagnosis of malignancy (ICD-9-CM code: 140.xx-239.xx) after renal transplantation. All patients were followed until the occurrence of endpoints or the end of the study (December 31, 2010), whichever came first. Adjusted risks of post-transplant cancer were analyzed using Cox proportional hazards regression model. All models were adjusted for baseline characteristics, comorbid diseases, transplant year, and exposure to immunosuppressive agents.


Among 642 renal transplant patients, 54 cancers (8.4 %) were identified. The median time between transplant and cancer diagnosis was 46.2 (range 8.5–107.4) months. Cancers of kidney and other unspecified urinary organs was the most common cancer sites, accounted for 18.5 % of the malignancies diagnosed. The next most common cancer sites were trachea, bronchus, and lung (14.8 %), bladder (13.0 %), liver and intrahepatic bile ducts (11.1 %), colon (5.6 %), and prostate (5.6 %). Age at transplantation was a statistically significant risk factor of post-transplant cancer in our study. Increased risks of post-transplant cancer were observed in patients who received immunosuppression agents (cyclosporine (HR 1.26, 95 % CI 0.58–2.77, p = 0.5603), tacrolimus (HR 1.99, 95 % CI 0.66–6.00, p = 0.2197), and mycophenolate (HR 1.00, 95 % CI 0.40–2.45, p = 0.9874)) although the estimates were not statistically significant.


Our population-based cohort study offers additional insight into post-transplant cancers in Asian population. Further studies are warranted to assess the association between specific immunosuppression agents and post-transplant cancers.


Renal transplantation Post-transplant cancer Immunosuppression agents 


  1. 1.
    Wolfe RA, Ashby VB, Milford EL et al (1999) Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341:1725–1730PubMedCrossRefGoogle Scholar
  2. 2.
    Agraharkar ML, Cinclair RD, Kuo YF, Daller JA, Shahinian VB (2004) Risk of malignancy with long-term immunosuppression in renal transplant recipients. Kidney Int 66:383–389PubMedCrossRefGoogle Scholar
  3. 3.
    Bosmans JL, Verpooten GA (2007) Malignancy after kidney transplantation: still a challenge. Kidney Int 71:1197–1199PubMedCrossRefGoogle Scholar
  4. 4.
    Villeneuve PJ, Schaubel DE, Fenton SS, Shepherd FA, Jiang Y, Mao Y (2007) Cancer incidence among Canadian kidney transplant recipients. Am J Transpl 7:941–948CrossRefGoogle Scholar
  5. 5.
    Webster AC, Craig JC, Simpson JM, Jones MP, Chapman JR (2007) Identifying high risk groups and quantifying absolute risk of cancer after kidney transplantation: a cohort study of 15,183 recipients. Am J Transpl 7:2140–2151CrossRefGoogle Scholar
  6. 6.
    Zeier M, Hartschuh W, Wiesel M, Lehnert T, Ritz E (2002) Malignancy after renal transplantation. Am J Kidney Dis 39:E5PubMedCrossRefGoogle Scholar
  7. 7.
    Sheil AG (1999) Patterns of malignancies following renal transplantation. Transpl Proc 31:1263–1265CrossRefGoogle Scholar
  8. 8.
    Holmes RD, Sokol RJ (2002) Epstein-Barr virus and post-transplant lymphoproliferative disease. Pediatr Transpl 6:456–464CrossRefGoogle Scholar
  9. 9.
    Karczewski M, Stronka M, Karczewski J, Wiktorowicz K (2011) Skin cancer following kidney transplantation: a single-center experience. Transpl Proc 43:3760–3761CrossRefGoogle Scholar
  10. 10.
    Cheung CY, Lam MF, Lee KC et al (2011) Renal cell carcinoma of native kidney in Chinese renal transplant recipients: a report of 12 cases and a review of the literature. Int Urol Nephrol 43:675–680PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Wu MJ, Lian JD, Yang CR et al (2004) High cumulative incidence of urinary tract transitional cell carcinoma after kidney transplantation in Taiwan. Am J Kidney Dis 43:1091–1097PubMedCrossRefGoogle Scholar
  12. 12.
    Hung YM, Chou KJ, Hung SY, Chung HM, Chang JC (2007) De novo malignancies after kidney transplantation. Urology 69:1041–1044PubMedCrossRefGoogle Scholar
  13. 13.
    Chiang YJ, Wang HH, Liu KL, Chu SH, Lee WC (2008) Hepatocellular carcinoma following renal transplantation: experience in northern Taiwan. Transpl Proc 40:2397–2399CrossRefGoogle Scholar
  14. 14.
    Hsu NW, Chuang FR, Chen YT, Chen CL, Cheng YF (2010) Hepatocellular carcinoma in kidney transplant recipients. Transpl Proc 42:811–813CrossRefGoogle Scholar
  15. 15.
    Hsiao FY, Yang CL, Huang YT, Huang WF (2007) Using Taiwan’s national health insurance research databases for pharmacoepidemiology research. J Food Drug Anal 15:99–108Google Scholar
  16. 16.
    Tsai YW, Hsiao FY, Wen YW et al (2013) Clinical outcomes of vertebroplasty or kyphoplasty for patients with vertebral compression fractures: a nationwide cohort study. J Am Med Dir Assoc 14:41–47PubMedCrossRefGoogle Scholar
  17. 17.
    Chen YM, Chen DY, Chen LK et al (2011) Alendronate and risk of esophageal cancer: a nationwide population-based study in Taiwan. J Am Geriatr Soc 59:2379–2381PubMedCrossRefGoogle Scholar
  18. 18.
    Hsiao FY, Huang WF, Chen YM et al (2011) Hip and subtrochanteric or diaphyseal femoral fractures in alendronate users: a 10-year, nationwide retrospective cohort study in Taiwanese women. Clin Ther 33:1659–1667PubMedCrossRefGoogle Scholar
  19. 19.
    de Monbrison F, Piens MA, Ample B, Euvrard S, Cochat P, Picot S (2004) Two cases of subcutaneous phaeohyphomycosis due to Exophiala jeanselmei, in cardiac transplant and renal transplant patients. Br J Dermatol 150:597–598PubMedCrossRefGoogle Scholar
  20. 20.
    Chang JS, Tsai CR, Tsai YW, Wiemels JL (2012) Medically diagnosed infections and risk of childhood leukaemia: a population-based case-control study. Int J Epidemiol 41:1050–1059PubMedCrossRefGoogle Scholar
  21. 21.
    Kasiske BL, Snyder JJ, Gilbertson DT, Wang C (2004) Cancer after kidney transplantation in the United States. Am J Transpl 4:905–913CrossRefGoogle Scholar
  22. 22.
    Falsarella PM, Alves-Filho G, Mazzali M (2008) Skin malignancies in renal transplant recipients: a Brazilian center registry. Transpl Proc 40:767–768CrossRefGoogle Scholar
  23. 23.
    Penn I (2000) Cancers in renal transplant recipients. Adv Ren Replace Ther 7:147–156PubMedGoogle Scholar
  24. 24.
    Vajdic CM, McDonald SP, McCredie MR et al (2006) Cancer incidence before and after kidney transplantation. JAMA 296:2823–2831PubMedCrossRefGoogle Scholar
  25. 25.
    van Leeuwen MT, Grulich AE, Webster AC et al (2009) Immunosuppression and other risk factors for early and late non-Hodgkin lymphoma after kidney transplantation. Blood 114:630–637PubMedCrossRefGoogle Scholar
  26. 26.
    Hibberd AD, Trevillian PR, Wlodarczyk JH et al (2013) Effect of immunosuppression for primary renal disease on the risk of cancer in subsequent renal transplantation: a population-based retrospective cohort study. Transplantation 95:122–127PubMedCrossRefGoogle Scholar
  27. 27.
    Caillard S, Lamy FX, Quelen C et al (2012) Epidemiology of post transplant lymphoproliferative disorders in adult kidney and kidney pancreas recipients: report of the French registry and analysis of subgroups of lymphomas. Am J Transpl 12:682–693CrossRefGoogle Scholar
  28. 28.
    Robson R, Cecka JM, Opelz G, Budde M, Sacks S (2005) Prospective registry-based observational cohort study of the long-term risk of malignancies in renal transplant patients treated with mycophenolate mofetil. Am J Transpl 5:2954–2960CrossRefGoogle Scholar
  29. 29.
    Euvrard S, Morelon E, Rostaing L et al (2012) Sirolimus and secondary skin-cancer prevention in kidney transplantation. N Engl J Med 367:329–339PubMedCrossRefGoogle Scholar
  30. 30.
    Bichari W, Bartiromo M, Mohey H et al (2009) Significant risk factors for occurrence of cancer after renal transplantation: a single center cohort study of 1,265 cases. Transpl Proc 41:672–673CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Graduate Institute of Clinical Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  2. 2.School of Pharmacy, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  3. 3.Department of PharmacyNational Taiwan University HospitalTaipeiTaiwan
  4. 4.Department of Computer Science and EngineeringNational Taiwan Ocean UniversityKeelungTaiwan
  5. 5.Institute of Information ScienceAcademia SinicaTaipeiTaiwan

Personalised recommendations