Postkidney Transplant Cancer: Incidence, Risk Factors, and Future Perspectives in a Real-World Analysis of a Single Italian Center

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Background: Our study aims to outline cancer epidemiology post-KTx, examine risk factors, and assess the impact on treatment and survival in a large cohort of kidney transplant patients. We’ll analyze the link between changes in immunosuppressive therapy post-cancer diagnosis and survival outcomes. Methods: Retrospective collection of data in KTx-ps transplanted between January 2004 and December 2021, subjected to outpatient follow-up with a median follow-up of 7 [1-19] years. Results: Our study included 930 KTx-ps, average age 49yrs. 91% had pre-KTx dialysis for about 52 months. Most received KTx from a deceased donor (84%). 74% had Basiliximab induction therapy, 26% ATG. Maintenance therapy mostly involved steroids (87%), tacrolimus (92%), ciclosporin (8%), and mycophenolate (94.6%). 177 patients (19%) had at least one cancer (CAN+). The mean time from KTx to oncological diagnosis was 83 months. Non-melanoma skin cancers (NMSC) were the most common tumors (55%), while solid tumors were observed in 38.6% of cases. Deceased donor was more represented in CAN+ . CAN+ were older and with higher BMI. They had greater presence of vasculitis as basic nephropathy. In the period between 2016 and 2021, induction therapy with ATG was significantly associated with CAN+. In multivariable analysis, ATG emerged as an independent risk factor for CAN+ (p=0.014) and, in survival analyses, ATG was strongly and significantly related to the earlier development of CAN+ (p=0.010). During follow up, cancer-related causes were the second cause of mortality (23%); the average time from cancer diagnosis to death was 23 months. The median survival from Ktx was 148 (CAN+) and 82 months (CAN-). After oncological diagnosis, significant evidence on tumor survival was derived from the shift to mTOR inhibitors compared to the group with definitive drug suspension (p=0.004). Conclusion: Our study confirms cancer’s significance as a KTx complication. ATG is an independent cancer risk factor, emphasizing the need for personalized immunosuppressive therapy at KTx to mitigate neoplastic risk. In KTx-ps, future research should focus on therapeutic strategies with antineoplastic agents and post-malignancy immunosuppression management.

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