1Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, NCI/NIH/DHHS, Bethesda, MD. Electronic address: firstname.lastname@example.org.
2New Jersey State Cancer Registry, New Jersey Department of Health, New Jersey.
3University of Hawaii Cancer Center, Honolulu, Hawaii; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
4Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, NCI/NIH/DHHS, Bethesda, MD.
5Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, NCI/NIH/DHHS, Bethesda, MD.
BACKGROUND & AIMS:
Studies of liver cancer risk in recipients of solid organ transplants have generally been small, yielding mixed results, and little is known about biliary tract cancers among transplant recipients.
We identified incident hepatobiliary cancers among 201,549 US recipients of solid organs, from 1987 through 2008, by linking data from the US transplant registry with 15 cancer registries. We calculated standardized incidence ratios (SIRs), comparing risk relative to the general population. We also calculated incidence rate ratios (RRs), comparing risk for hepatocellular carcinoma (HCC) and total (intrahepatic and extrahepatic) cholangiocarcinoma among subgroups of recipients.
Of transplant recipients, 165 developed hepatobiliary cancers (SIR, 1.2; 95% confidence interval [CI], 1.0-1.4). HCC risk was increased among liver recipients (SIR, 1.5; 95% CI, 1.0-2.2), especially 5 or more y after transplant (SIR, 1.8; 95% CI, 1.0-3.0). Cholangiocarcinoma was increased among liver (SIR, 2.9; 95% CI,1.6-4.8) and kidney recipients (SIR, 2.1; 95% CI, 1.3-3.1). HCC was associated with hepatitis B virus (RR, 3.2; 95% CI, 1.3-6.9), hepatitis C virus (RR, 10; 95% CI, 5.9-16.9), and non-insulin-dependent diabetes (RR, 2.5; 95% CI, 1.2-4.8). Cholangiocarcinoma was associated with azathioprine maintenance therapy (RR, 2.0; 95% CI, 1.1-3.7). Among liver recipients, primary sclerosing cholangitis (PSC) was associated with increased risk of cholangiocarcinoma, compared to the general population (SIR, 21; 95% CI, 8.2-42) and compared to liver recipients without PSC (RR, 12.3; 95% CI, 4.1-36.4).
Risks for liver and biliary tract cancer are increased among organ transplant recipients. Risk factors for these cancers include medical conditions and medications taken by recipients.