Cancer is an important outcome in kidney transplantation, but the scope and consistency of how cancer is defined and reported in trials involving kidney transplant recipients has not been evaluated. This study aimed to assess the range and variability of cancer outcomes in trials involving kidney transplant recipients.
Transformar la vida de las personas con cáncer y trasplantes de órganos a través de la atención a la salud y la investigación integradas.
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El Centro de Innovaciones en Cáncer y Trasplantes se creó con los siguientes objetivos:
- Brindar una excelente atención clínica multidisciplinar a pacientes con cáncer antes y después de un trasplante.
- Liderar investigación excepcional, multidimensional y centrada en el paciente del cáncer antes y después del trasplante de órganos con un biorregistro extenso y una red de investigación colaborativa.
Buscarnos lograrlo con una clínica pionera, un biorregistro nuevo, y investigación original.
Conozca más sobre el Centro
Clínica
Una clínica pionera para alinear la atención entre las especialidades de trasplante y cáncer.
Biorregistro
Un registro para integrar los datos de pacientes de múltiples centros oncológicos y programas de trasplante de todo el mundo.
Investigación
Investigar los mecanismos inmunológicos y la epidemiología del cáncer con trasplante de órganos sólidos.
Publicaciones recientes
Scope and Consistency of Cancer Outcomes Reported in Randomized Trials in Kidney Transplant Recipients
Eric H Au…Christopher D Blosser…Jonathan C Craig
Kidney International Reports
8(2):274-281
Original Work
DOI: 10.1016/j.ekir.2022.10.032
PMID: 36815120
The ClinicalTrials.gov database was searched from February 2000 to July 2021 to identify all randomized controlled trials (RCTs) in adult kidney transplant recipients, and which included cancer as a specified outcome. The definition of cancer, types of cancer (if any), timepoint(s) of measurement and method of aggregation were extracted for each cancer outcome.
Of the 819 trials in kidney transplantation, only 84 (10%) included 1 or more cancer outcomes. Of these, 72 of 84 (86%) trials included cancer as a secondary outcome and 12 of 84 (14%) considered cancer as a primary outcome. The most frequent description of cancer was “malignancy” (n = 44, 43%), without reference to diagnostic criteria, histology, grade, or stage. The 2 most common cancer types were posttransplant lymphoproliferative disorder (PTLD) (n = 20, 20%) and nonmelanoma skin cancer (n = 10, 10%). Several methods of aggregation were identified, including incidence or rate (n = 47, 46%), frequency or proportion (n = 30, 29%), and time to event (n = 5, 5%). Approximately half the cancer outcomes were measured at a single time point (n = 44, 52%).
Cancer is an infrequently reported outcome and is inconsistently defined in trials of kidney transplant recipients. Consistent reporting of cancer outcomes using standardized definitions would provide important information on the impact of cancer in patients after kidney transplantation.
Evaluation of the Modified Oxford Score in Recurrent IgA Nephropathy in North American Kidney Transplant Recipients: The Banff Recurrent Glomerulonephritis Working Group Report
Nada Alachkar…Christopher D Blosser…Serena M Bagnasco
Transplantation
107(9):2055-2063
Original Work
DOI: 10.1097/TP.0000000000004640
PMID: 37202854
The modified Oxford classification mesangial and endocapillary hypercellularity, segmental sclerosis, interstitial fibrosis/tubular atrophy, and the presence of crescents (MEST-C) of immunoglobulin A nephropathy (IgAN) was recently shown to be a predictor of graft failure in Asians with recurrent IgAN. We aimed to validate these findings in a cohort from North American centers participating in the Banff Recurrent Glomerulopathies Working Group.
We examined 171 transplant recipients with end-stage kidney disease because of IgAN; 100 of them with biopsy-proven recurrent IgAN (57 of them had complete MEST-C scores) and 71 with no recurrence.
IgAN recurrence, which was associated with younger age at transplantation ( P = 0.012), strongly increased the risk of death-censored graft failure (adjusted hazard ratio, 5.10 [95% confidence interval (CI), 2.26-11.51]; P < 0.001). Higher MEST-C score sum was associated with death-censored graft failure (adjusted hazard ratio, 8.57 [95% CI, 1.23-59.85; P = 0.03] and 61.32 [95% CI, 4.82-779.89; P = 0.002] for score sums 2-3 and 4-5 versus 0, respectively), and so were the single components endocapillary hypercellularity, interstitial fibrosis/tubular atrophy, and crescents ( P 0.05).
Our findings may validate the prognostic usefulness of the Oxford classification for recurrent IgAN and support the inclusion of the MEST-C score in allograft biopsies diagnostic reports.
Transplant Onconephrology: An Update
Christopher D Blosser, Andrew J Portuguese, Cecilia Santana, Naoka Murakami
Seminars in Nephrology
42(6):151348
Review
DOI: 10.1016/j.semnephrol.2023.151348
PMID: 37209580
Transplant onconephrology is a growing specialty focused on the health care of kidney transplant recipients with cancer. Given the complexities associated with the care of transplant patients, along with the advent of novel cancer therapies such as immune checkpoint inhibitors and chimeric antigen-receptor T cells, there is a dire need for the subspecialty of transplant onconephrology. The management of cancer in the setting of kidney transplantation is best accomplished by a multidisciplinary team, including transplant nephrologists, oncologists, and patients. This review addresses the current state and future opportunities for transplant onconephrology, including the roles of the multidisciplinary team, and related scientific and clinical knowledge.