MALIGNANT DISEASE IN PATIENTS WITH LONG-TERM RENAL-TRANSPLANTS

The incidence of de novo malignancy was analyzed in 274 renal transpla nt recipients whose graft had functioned for at least 3 years and who had been followed for 2622 patient-years and individually for up to 29 years, The actuarial incidence and relative risks (RR) of tumor devel opment (compared with National statistics) were calculated. Subgroup a nalysis was performed according to age, sex, the number of years and t ype of immunosuppression, and the tumor type, Seventy one tumors occur red in 54 patients, Skin tumors were the most common, followed by lymp homa, renal, bladder, and bronchial carcinoma. The actuarial cumulativ e risks of tumor development were 18.4% (95% confidence interval [CI] 12.4-24.3%) at 10 years and 49.6% (95% CI 36.3-62.0%) at 20 years, The overall RR of developing a tumor was 6.2 but was higher for men (RR 7 .3) than women (RR 4.9), The RR of developing skin cancers, but not ot her malignancies, increased from 6.6 at 5 years to 20 after >15 years. There was no evidence that cyclosporine-treated patients had an incre ased incidence of tumors, indeed the risk may be less in patients trea ted with cyclosporine and low-dose azathioprine than in those treated with azathioprine and prednisolone alone after more than 5 years.