SP662CANCER-RELATED OUTCOMES IN KIDNEY ALLOGRAFT RECIPIENTS IN ENGLAND VERSUS NEW YORK STATE: A COMPARATIVE POPULATION-COHORT ANALYSIS BETWEEN 2003 AND 2013

Abstract

Introduction and Aims: Global studies have confirmed higher cancer-related incidence and mortality for kidney allograft recipients versus the general population. However, no study has compared cancer-related epidemiology between different population cohorts and it is unclear whether country-specific data is translatable across countries. In this population-cohort study, we compared cancer-related incidence and mortality in kidney allograft recipients in England versus New York State. Method(s): We obtained data from every kidney-alone transplant procedure performed in England and New York State between 2003 and 2013, collecting patient demographics that included age, gender, donor type (living or deceased), transplant year, medical co-morbidities and ethnicity. Cancer data was derived from ICD-10 and ICD-9 codes from English and New York State cohorts respectively. English data was extracted from Hospital Episode Statistics, with linkage to the Office for National Statistics for mortality data. New York State data was extracted from Statewide Planning and Research Cooperative System (SPARCS). Result(s): Data was analysed for 18,493 and 11,602 patients from England and New York State respectively, with median follow up in England and New York State 6.3 years and 5.5 years respectively. Baseline demographics revealed English patients were younger and more likely to be of White ethnicity compared to New York State patients, but no difference was observed in gender between the cohorts. English patients were significantly less likely to have a history of pre-transplant cancer compared to New York State patients (0.8% versus 3.1%, p<0.001). Admissions to hospital post kidney transplantation with a cancer diagnosis was more common in England versus New York State (12.3% versus 5.9%, p<0.001). Cancer-incidence was disparate between the two different cohorts; English compared to New York State patients were more likely to develop cancers of the skin (5.3% versus 0.3%, p<0.001), breast (0.5% versus 0.2%, p=0.001), bladder (0.3% versus 0.2%, p=0.01) and post-transplant lymphoproliferative disease (1.6% versus 1.1%, p=0.001), but less likely to get cancer of the lung (0.4% versus 0.7%, p<0.001). Kidney allograft recipients in England had lower mortality compared to their New York State counterparts during the immediate post-operative stay (0.7% versus 1.0%, p=0.011), after 30-days (0.9% versus 1.8%, p<0.001) and after 1-year post-transplantation (3.0% versus 5.1%, p<0.001). Logistic regression analysis demonstrated patients admitted with cancer within the first year post-transplant were more likely to die within the first 12 months in England (Odds Ratio 4.28 [95% CI 3.09 - 5.93], p-value <0.001) and New York State (Odds Ration 2.88 [95% CI 1.70 - 4.89], p<0.001). Conclusion(s): Kidney allograft recipients in England compared to New York State have different cancer-related epidemiology and outcomes. Our analysis demonstrates significant differences between kidney allograft recipients in England versus New York States and suggests caution in translating post-transplant cancer-related epidemiology between different countries. However, in both countries we observed admission with cancer within the first year post kidney transplantation is associated with increased risk for mortality.