The general population is aging with chronic diseases, resulting in more cancer and solid organ transplantation. As such, there are an increasing number of people with both cancer and organ transplant. Solid organ transplant recipients (SOTRs) have a two-to-four times greater risk of cancer due to older age, oncogenic viruses (e.g. Epstein-Barr Virus) and immunosuppression to prevent transplant rejection. Additionally, an increasing number of SOTRs have a history of pre-transplant malignancy, which increases the risk for post-transplant cancer. The combination of cancer and solid organ transplantation presents significant challenges for patients, including increased risk of death and transplant rejection and the need for intensive and invasive treatments.
Oncology is rapidly developing new immunotherapies, including immune checkpoint inhibitors (ICIs). ICIs are approved for nearly half of adult cancer patients with advanced solid tumors. Yet, ICIs cause transplant rejection, off-target effects, and cancer progression in SOTRs. Much remains unknown for safe use of ICIs in SOTRs, especially in racial and ethnic minority populations who experience lower access to transplant and worse transplant and patient survival.
These poorer outcomes are possibly due to social determinants of health (SDH), including economic stability, education, neighborhood and the built environment, social and community context, and health and health care access. Yet, the impact of SDH on SOTRs at risk for or with cancer (and other common conditions) is unknown. These knowledge gaps present opportunities for patient-centered research to better understand the risks and molecular pathways involved in order to improve cancer screening, biomarkers and treatments for SOTRs.
Unfortunately, clinical care has been delivered in silos of distinct clinic and hospital spaces which limits the quality of care, especially for patients with complex health conditions.
Lack of Bioregistries
There is no active patient-level bioregistry to study solid organ transplant candidates or recipients with cancer. Moreover, research of cancer in transplant patients receives minimal federal funding. Without a bioregistry, many fundamental questions about cancer and transplant will remain unanswered.
In response to unmet patient needs, Dr. Christopher Blosser has become an international expert on the intersection between cancer and solid organ transplants. His research is focused on investigations of the immune mechanisms and epidemiology of cancer with solid organ transplantation, with publications listed below.
Our research is translational, epidemiological, and patient-reported:
- Investigating the risks and outcomes of current cancer treatments in pre- and post-transplant patients, including for self-reported racial and ethnic minority solid organ transplant recipients (SOTRs).
- Studying patient-reported health conditions and whether specific cancer and transplant outcomes in SOTRs are associated with structural and individual racism and social determinants of health (access to healthcare, economic stability, access to education, social and community support).
- Understanding patient- and caregiver-reported experience with cancer and organ transplant to improve clinical care.
- Leading translational research (i.e. findings from the lab to be applied to humans) to improve diagnostic tests and therapies.
CD19 CAR-T therapy in solid organ transplant recipients: case report and systematic review. Portuguese AJ, Gauthier J,…Blosser CD. Bone Marrow Transplantation. 2022. Dec. [Original Work]. DOI: 10.1038/s41409-022-01907-z
Immune checkpoint inhibitor use in solid organ transplant recipients: a systematic review. Portuguese AJ, Tykodi S, Blosser CD,…Hall ET. JNCCN. 2022. Apr. [Invited Review, Accepted]. DOI: 10.6004/jnccn.2022.7009
Changes in Cancer Incidence and Outcomes among Kidney Transplant Recipients in the United States Over a Thirty-Year Period (1987-2016). Blosser CD, Haber G, Engels EA. Kidney International. 2021 Jun;99(6):1430-1438. [Original Work]. DOI: 10.1016/j.kint.2020.10.018
Immune checkpoint inhibitors in kidney transplant patients: a multi-center study. Murakami N, …Blosser CD, …Jhaveri K. Kidney International. 2021 Jul;100(1):196-205. [Original Work]. DOI:10.1016/j.kint.2020.12.015.
Kidney Recipients with Allograft Failure, Transition of Kidney Care (KRAFT): A Survey of Contemporary Practices of Transplant Providers. Alhamed T, …Blosser CD,…et al. Am Journal of Transplantation. DOI: 10.1111/ajt.16523.
A Call to Action: The Need for Improved Transplant Cancer Screening Guidelines. Blosser CD. Am J Transplant. 2016 Sep 2. [editorial]. PMID: 27589841.
Cancer & Transplantation — Comprehensive Review Series. Blosser CD, Series Editor. AJT Supplement. November 2020.