Epidemiology of Cancer After Solid Organ Transplant (EpCOT): Dataset Overview

Purpose: Post-transplant cancer is common and a leading cause of mortality. However, published literature is dated, heterogenous and/or provides conflicting results. Our aim is to analyse incidence, mortality and associated morbidity of post-transplant cancer using national record-linked transplant registry data for a robust and contemporary analysis. In this abstract, we provide a summary overview of granular outcomes for cancer, mortality and hospitalisation events.

Methods: Epidemiology of Cancer post solid Organ Transplant (EpCOT) linked UK Transplant Registry data (held by NHS Blood & Transplant), cancer registry data (previously held by Public Health England), plus admissions and mortality data (held by NHS England). All solid organ transplant recipients in England between 1985 and 2015 were included and any recorded cancer episode, death or hospitalisation into any English hospital was captured with outcomes to 2023.

Results: EpCOT holds data for 65,817 patients who received 71,489 solid organ transplants between 1985-2015. The majority (67.4%) are kidney transplant recipients, followed by liver transplant recipients (17.66%). Recipient demographics are 61.41% male, 67.9% white ethnicity and median age 46 years (6,023 transplants were performed in children under 18). Pre-transplant history of cancer was recorded for 1,761 recipients. De novo post-transplant cancer was recorded for 5,341 recipients (8,931 including non-melanoma skin cancer). Death occurred in 27,422 recipients: cardiovascular disease (25.5%), cancer (16.7%), infection (14.0%) and other causes (43.8%). Exploring cancer deaths, lung cancer was the most common (16.2%) followed by lymphoma (12.6%). Hospitalisation data was available for a cohort between November 1993 and March 2019 (n=57,068 recipients). This cohort had 971,924 hospital admissions lasting at least 1 day (mean admission length of 9 days) and underwent 6.8 million operations, interventions and /or procedures as classified by administrative coding (OPCS-4) which includes in-patient dialysis sessions.

Conclusions: EpCOT is one of the largest and most comprehensive national record linkages of solid organ transplant recipients in the world. It will allow us to analyse the incidence and survival of cancer after solid organ transplantation and estimate the morbidity requiring hospitalisation. Ultimately, we anticipate EpCOT will provide detailed insight into cancer epidemiology for our recipients and inform clinical practice to reduce the burden of post-transplant cancer.