Cancer-Related Mortality After Solid Organ Transplantation in England: The EpCOT Study

Purpose: Post-transplant cancer is a leading cause of mortality. However, published literature is dated, heterogenous and/or provides conflicting mortality rates. Our aim was to analyse post-transplant cancer mortality using national record-linked transplant registry data.

Methods: Epidemiology of Cancer after solid Organ Transplantation (EpCOT) linked UK Transplant Registry data (held by NHS Blood & Transplant), cancer data (previously held by Public Health England), and administration and mortality data (held by NHS England) between 1985-2015 with outcomes to 2023. In this analysis, cancer-related mortality for 2001-2022 was assessed using standardized mortality ratios (SMR) and confident intervals (CI).

Results: Our cohort included 40,267 solid-organ transplant recipients, accounting for 448,071 person-years (median years follow-up 10.9, interquartile range 7.8-15). We observed 14,576 (36.2%) deaths, with 2,648 (18.2%) attributed to cancer. Transplantation was associated with increased cancer-related mortality; SMR 1.95 (95% CI: 1.87-2.05) for men and 2.18 (95% CI 2.04-2.32) for women. Considerable differences were seen stratified by graft type. For example, liver transplant recipients have increased SMR for cancer-related death; 3.12 (95% CI 3.04-3.61) for men and 2.78 (95% CI: 2.43-3.18) for women, whilst simultaneous kidney-pancreas transplant recipients showed no increased SMR; 1.18 (95% CI: 0.86-1.6) for men and 1.44 (95% CI: 0.96-2.17) for women. Transplantation was associated with increased mortality for most cancers, notably non-Hodgkin lymphoma, liver and kidney, whilst the inverse appears to be true for prostate cancer (SMR 0.43 95% CI: 0.33-0.56).

Conclusions: Transplant recipients in England have increased cancer-related mortality but this isn’t uniform. EpCOT aims to provide detailed epidemiological analyses to inform clinical practice to reduce the burden of post-transplant cancer.