Health Care Utilization and Cancer Incidence Following Solid Organ Transplant
transplant, cancer incidence
Background/Aims: Population-based registry studies have found increases in lung, kidney, skin and thyroid cancers among organ transplant recipients compared with the general population. These studies link data from national transplant services and state cancer registries, thereby limiting the ability to describe recommended health care utilization, including preventive services (e.g. influenza vaccinations) and outpatient visits (9 within transplant year), and incident diagnoses of hypertension and diabetes (estimated to be 50% and 18%, respectively). The goal of this study was to characterize health care utilization and cancer incidence among solid organ transplant recipients in Kaiser Permanente Southern California (KPSC).
Methods: KPSC transplant registry data was linked to electronic medical records on solid organ transplants from 1990 to 2014. Data was stratified by kidney, liver, heart and lung transplants.
Results: Among 4,336 transplant recipients, 62% (2,703/4,336) were white, 80% (3,621/4,336) were > 35 years old, 27% (1,158/4,336) were past smokers and the mean membership length was 5.6 years. Past smoking was highest for lung transplant recipients (34%, 63/185) and liver transplant recipients (33%, 418/1,271). Survival among all transplant recipients was 89% at 2 years posttransplant yet decreased to 65% at 10 years, with the lowest survival among lung recipients (35% at 10 years). Within the first year posttransplant, recipients had a mean number of 5 primary care visits, 7 nephrology visits and 2 visits each for dermatology, urology, and obstetrics and gynecology (women). Influenza vaccination rates have increased over time and were as high as 96% among lung recipients during the 2014-2015 influenza season. Roughly, 12% (322/2,601) and 14% (151/1,082) of transplant recipients had an incident diagnosis of hypertension and diabetes. Finally, there was increased risk of all cancers excluding nonmelanoma skin cancer (standardized incidence ratio: 2.15, 95% confidence interval: 1.93–2.39), with the largest incidence for non-Hodgkin’s lymphoma, lung cancer and kidney cancer.
Conclusion: Transplant recipients in KPSC met the recommended number of outpatient visits, including specialty care visits, within the first year posttransplant. Incidences of hypertension and diabetes were lower than expected, and influenza vaccination rates were high. There was a twofold increase in cancer incidence among the solid organ transplant population.
Ghai NR, Jacobsen SJ, Silverberg MJ, Kogut NM, Valencia MA, Yu CL, Quinn VP. Health care utilization and cancer incidence following solid organ transplant. J Patient Cent Res Rev. 2016;3:175-6.