Solid organ transplantation and survival among individuals with a history of cancer.

Background The success of immunotherapy highlights a possible role for immunity in controlling cancer during remission for cancer patients in the general population. A prior cancer diagnosis is common among solid organ transplant candidates, and immunosuppressive medications administered to transplant recipients may increase recurrence risk. Methods Using linked data from the United States solid organ transplant registry and 13 cancer registries, we compared overall and cancer-specific survival among cancer patients who did vs. did not receive subsequent transplantation. We used Cox regression in cohort and matched analyses, controlling for demographic factors, cancer stage, and time since cancer diagnosis. Results The study included 10,524,326 cancer patients with 17 cancer types; 5425 (0.05%) subsequently underwent solid organ transplantation. The median time from cancer diagnosis to transplantation was 4.17 years. Transplantation was associated with reduced overall survival for most cancers, especially cervical, testicular, and thyroid cancers (adjusted hazard ratios [aHRs] for overall mortality: 3.43-4.88). In contrast, transplantation was not associated with decreased cancer-specific survival for any cancer site, and we observed inverse associations for patients with breast cancer (aHRs for cancer-specific mortality: 0.65-0.67), non-Hodgkin lymphoma (0.50-0.51), and myeloma (0.39-0.42). Conclusions Among US cancer patients, subsequent organ transplantation was associated with reduced overall survival, likely due to end-stage organ disease and transplant-related complications. However, we did not observe adverse associations with cancer-specific survival, partly reflecting careful candidate selection. Impact These results do not demonstrate a detrimental effect of immunosuppression on cancer-specific survival and support current management strategies for transplant candidates with previous cancer diagnoses.