Transplant Patients Have Worse Cancer Outcomes, Analysis Shows

ScienceDaily (May 17, 2009) — After comparing two patient cancer registries—one featuring transplant patients and the other the general population—researchers at the University of Cincinnati (UC) have found that transplant patients experience worse outcomes from cancer.

These results will be published in the May 15, 2009, edition of the journal Transplantation, which is currently in press.

Yun Miao, MD, PhD, Jason Everly, PharmD, Steve Woodle, MD, and colleagues at UC compared lung, colon, breast, prostate, bladder, kidney and skin cancer data in 635 adult transplant recipients from the Israel Penn International Transplant Tumor Registry with that of about 1.2 million adults from the general population in the Surveillance, Epidemiology and End Results (SEER) database.

"It has been known for some time that transplant recipients are at an increased risk of developing cancer, but the outcomes of cancers that arise in organ transplant recipients have not been defined," says Woodle, professor and chief of transplant surgery and co-author of the study.

"In this study, we wanted to examine the influence of transplantation on the outcomes of individual types of cancers arising in organ transplant recipients," adds Miao, co-author and research fellow in the division.

The Israel Penn International Transplant Tumor Registry is the largest and most comprehensive transplant tumor registry in the world and was created by doctors at the UC College of Medicine.

The SEER registry collects information on cancer incidence, survival and prevalence for roughly 26 percent of the United States population and compiles reports and statistics based on this information along with cancer mortality rates for the entire nation.

A comparison of results in transplant recipients to the general population also demonstrated that transplant patients were more likely to have early stage renal cell (kidney) cancer and more advanced colon, breast, bladder and skin cancer at the time of diagnosis.

Disease-specific survival was worse in the transplant population for each of these seven cancers analyzed and was a negative risk factor for survival.

Now, researchers want to conduct further studies to find out why this may be the case.

"Transplant patients receive immunosuppressive therapies to prevent them from rejecting transplanted organs," says Woodle. "We want to see if immunosuppressive therapies contribute to the poorer outcomes in transplant recipients."

He says the worse outcomes in transplant recipients may have occurred because this population is not as healthy as the general population or because their cancers may be more aggressive as a result of their immunosuppression treatments.

"Some of our data supports this premise, as the extent of the cancers at diagnosis were greater in the transplant recipients," Woodle continues. "This was surprising since transplant recipients are generally followed more closely than the general population."

Everly, co-author and board-certified oncology pharmacist in the division, says that this data may change the way physicians screen transplant patients for cancer.

"We found that most cancers developed within five years following transplantation," he says, noting that more frequent and detailed checks should be made in order to catch the cancer in its earliest stages. "This may alter the way doctors should screen these patients for cancer."

This study was investigator-initiated and supported by research grants from Astellas Pharmaceuticals.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

In Great Britain, register at NHS Organ Donor Register

In Australia, register at Australian Organ Donor Register

Your generosity can save up to eight lives with heart, kidneys, liver, lungs, pancreas and small intestine transplants. One tissue donor can help up to 100 other people by donating skin, corneas, bone, tendon, ligaments and heart valves

New hope for organ recipients

Wouldn't it be wonderful if organ recipients did not have to worry about their immune systems rejecting their new organs? Maybe some day in the future a treatment will be developed to prevent rejection and this article offers hope for one potential solution.

By Danny Rose, Medical Writer theage.com.au

Australian scientists have stumbled across a "weird" effect within the immune system that offers hope of a new treatment to help transplant recipients accept their donor organs.

Researchers at Sydney's Garvan Institute set out to investigate how inflammation works in transplants with an experiment using the immune system's most powerful "activator" - a hormone called B cell activating factor or BAFF.

Mice were genetically engineered to produce large amounts of BAFF, in the expectation studies would show how their boosted immune systems would rapidly reject any foreign tissue.

But the exact opposite happened, as the mice accepted their tissue transplants without the need for conventional treatment to suppress the immune system.

"I went to my boss and said `Hey, look at this. This is really weird'," Garvan Institute masters student Stacey Walters said of the moment she made the discovery.

Dr Shane Grey, of the institute's Immunology and Inflammation Program, said he and fellow scientists were "floored".

"Trolling through the scientific literature would make you think `Wow, this BAFF molecule is a very powerful activator of the immune system'," he said.

"To come out with a finding to say that having more of it prevents inflammation, and stops T cells from destroying tissues, at the outset it seems so surprising."

T cells are white blood cells that play a direct role in killing off foreign tissue, and Dr Grey said it seemed the extra BAFF - which led to a higher number of regulating B cells in the blood - had increased T cell tolerance.

The surprise discovery could lead to a targeted treatment for organ transplant recipients, as conventional methods suppress the whole immune system and place already sick people at risk of further illness.

"What we'd like to be able to do is say here's your organ graft and here's some therapies that actually modulate the immune system that is attacking (it)," Dr Grey said.

"But everything else is still working fine - you still have a viral response, you're still making antibodies, you can still clear other infections.

"This provides a lot of hope to say these strategies will happen."

The findings are published in the Journal of Immunology.

“You Have the Power to Save Lives – Sign Your Donor Card & Tell Your Loved Ones of Your Decision”

Register to be a donor in Ontario or Download Donor Cards from Trillium Gift of Life Network
For other Canadian provinces click here

In the United States, be sure to find out how to register in your state at ShareYourLife.org or Download Donor Cards from OrganDonor.Gov

In Great Britain, register at NHS Organ Donor Register

In Australia, register at Australian Organ Donor Register

Your generosity can save up to eight lives with heart, kidneys, liver, lungs, pancreas and small intestine transplants. One tissue donor can help up to 100 other people by donating skin, corneas, bone, tendon, ligaments and heart valves