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Pancreatic cancer among solid organ transplant recipients in the United States
Journal article   Open access   Peer reviewed

Pancreatic cancer among solid organ transplant recipients in the United States

Tomohiro Tanaka, Charles F Lynch, Kelly J Yu, Bozena M Morawski, Mei-Chin Hsieh, Georgetta Alverson, April A Austin, Yun Zeng and Eric A Engels
Journal of cancer research and clinical oncology, Vol.149(7), pp.3325-3333
2023
DOI: 10.1007/s00432-022-04227-3
PMID: 35932302
url
https://www.ncbi.nlm.nih.gov/pmc/articles/11797600View
Open Access

Abstract

Introduction Pancreatic cancer (PC) in solid organ transplant (SOT) recipients is not well studied. Some PC cases may be incidentally detected during hepatobiliary imaging. Methods We evaluated PC among 374,106 SOT recipients during 1995–2017 in the United States using linked data from the national transplant registry and multiple state/regional cancer registries. Standardized incidence ratios (SIRs) were used to compare PC risk in recipients to the general population. We used multivariate Poisson regression to identify independent risk factors for PC. We assessed survival after PC diagnosis using Kaplan–Meier curves and log-rank tests. Results SOT recipients had elevated incidence for PC compared with the general population (SIR 1.40, 95% CI 1.29–1.52), and this increase was strongest in liver recipients (1.65, 1.41–1.92). Among all recipients, PC incidence was especially increased for cases arising in the head of the pancreas (SIR 1.50, 95% CI 1.34–1.68) and for cases diagnosed at localized stage (1.85, 1.37–2.44). Among SOT recipients, factors independently associated with increased incidence were consistent with those in general population including male sex, older age, non-O blood type, and history of diabetes. Additionally, compared to other organ recipients, liver transplant recipients had higher PC incidence (adjusted incidence rate ratio 1.28; 95% CI 1.06–1.54). Overall survival after PC diagnosis was poor (median 4 months) and similar between liver and other organ transplant recipients (p = 0.08). Conclusions PC incidence is elevated among SOT recipients, and more commonly diagnosed in liver transplant recipients perhaps related to incidental detection. However, survival is poor even in liver recipients, arguing against routine PC screening.

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