LATEBREAKER
Cancer
Spectrum of cancer risk in Asian American, Native Hawaiian, and other Pacific Islander Populations After Solid Organ Transplantation in the United States Jun Tao* Jun Tao Jaimie Z. Shing Kelly Yu Aimée R. Kreimer Mei-Chin Hsieh Karen Pawlish Jie Li Baozhen Qiao Eric A Engels
Background: Solid organ transplantation (SOT) is a lifesaving therapy for patients with end-stage organ disease; however, immunosuppressive agents used to prevent graft rejection increase cancer risk. While this has been well described among White, Black, and Hispanic SOT recipients in the United States, cancer risk in Asian American (AA), Native Hawaiian, and other Pacific Islander (NHPI) SOT recipients is ill-defined. We aim to describe and compare cancer risk among AA and NHPI SOT recipients in the US.
Methods: Cancer cases in AA and NHPI SOT recipients during 1990-2019 were obtained from the Transplant Cancer Match study, a linkage of the US transplant registry with 34 population-based cancer registries in the US. For each cancer type, we calculated a standardized incidence ratio (SIR) comparing incidence among SOT recipients with incidence in the general US population, by race (AA and NHPI). Expected cancers in the general AA and NHPI populations were calculated using rates from the Surveillance, Epidemiology, and End Results program. Among SOT recipients, incidence rate ratios (IRRs) for each cancer type were calculated, comparing risk between NHPI and AA populations.
Results: During 1990-2019, a total of 22,971 AA and 1,793 NHPI individuals received SOT (57.9% male, median age of 51 at transplantation). Compared to the general AA population, AA SOT recipients had a higher risk of overall cancers (SIR=1.7, 95%CI=1.6-1.8) and several cancers, most notably Kaposi sarcoma (15.3, 6.6-30.2), non-epithelial skin cancer (9.8, 5.4-16.5), anal cancer (7.9, 3.6-15.1), renal pelvis cancer (7.4, 3.7-13.2), non-Hodgkin lymphoma including chronic lymphocytic leukemia (NHL/CLL, 6.4, 5.6-7.3), and Hodgkin lymphoma (6.1,2.8-11.7). Other elevated SIRs among AA SOT recipients were cancers of the stomach, bladder, thyroid, and kidney, and leukemia (SIR range=1.8-5.3). Compared to the general NHPI population, NHPI SOT recipients had a higher risk of total cancers (SIR=1.3, 95%CI=1.0-1.5) and NHL/CLL (4.5, 2.3-7.9). Compared with AA SOTs, NHPI SOTs had a higher risk of pancreatic cancer (IRR=3.7, 95%CI=1.6-8.6) and skin melanoma (6.7, 1.2-36.4).
Conclusion: This study highlights the elevated cancer risk among AA and NHPI SOT recipients compared with the general AA and NHPI populations. The spectrum of cancer risk resembles what has been observed in other racial/ethnic SOT recipients, with an elevated risk for virus-related cancers due to immunosuppression during SOT therapy.