Publications

Here’s a list of research we’ve produced.

Immune checkpoint inhibitors in kidney transplant patients: a multi-center study

Naoka Murakami, … Christopher D. Blosser, … Kenar D. Jhaveri
Kidney International
100(1):196-205
Original Work
DOI: 10.1016/j.kint.2020.12.015

Immune checkpoint inhibitors (ICIs) are widely used for various malignancies. However, their safety and efficacy in patients with a kidney transplant have not been defined. To delineate this, we conducted a multicenter retrospective study of 69 patients with a kidney transplant receiving ICIs between January 2010 and May 2020. For safety, we assessed the incidence, timing, and risk factors of acute graft rejection. For efficacy, objective response rate and overall survival were assessed in cutaneous squamous cell carcinoma and melanoma, the most common cancers in our cohort, and compared with stage-matched 23 patients with squamous cell carcinoma and 14 with melanoma with a kidney transplant not receiving ICIs.

Following ICI treatment, 29 out of 69 (42%) patients developed acute rejection, 19 of whom lost their allograft, compared with an acute rejection rate of 5.4% in the non-ICI cohort. Median time from ICI initiation to rejection was 24 days. Factors associated with a lower risk of rejection were mTOR inhibitor use (odds ratio 0.26; 95% confidence interval, 0.09-0.72) and triple-agent immunosuppression (0.67, 0.48-0.92). The objective response ratio was 36.4% and 40% in the squamous cell carcinoma and melanoma subgroups, respectively. In the squamous cell carcinoma subgroup, overall survival was significantly longer in patients treated with ICIs (median overall survival 19.8 months vs. 10.6 months), whereas in the melanoma subgroup, overall survival did not differ between groups. Thus, ICIs were associated with a high risk of rejection in patients with kidney transplants but may lead to improved cancer outcomes. Prospective studies are needed to determine optimal immunosuppression strategies to improve patient outcomes.
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Changes in cancer incidence and outcomes among kidney transplant recipients in the United States over a thirty-year period (1987-2016)

Christopher D. Blosser, Gregory Haber, Eric A. Engels
Kidney International
99(6):1430-1438
Original Work
DOI: 10.1016/j.kint.2020.10.018

Recipients of kidney transplants have elevated cancer risk compared with the general population. Improvements over time in transplant care and cancer treatment may have affected incidence and outcomes of cancer among recipients of kidney transplant. To evaluate this, we used linked United States transplant and cancer registry data to study 101,014 adult recipients of kidney transplants over three decades (1987-1996, 1997-2006, 2007-2016). Poisson regression was used to assess trends in incidence for cancer overall and seven common cancers. Associations of cancer with risk of death-censored graft failure (DCGF) and death with functioning graft (DWFG) were evaluated with Cox regression. We also estimated absolute risks of DCGF and graft failure following cancer for recipients transplanted in 2007-2016.

There was no significant change in the incidence of cancer overall or for six common cancers in recipients across the 1987-2016 period. Only the incidence of prostate cancer significantly decreased across this period after multivariate adjustment. Among recipients of kidney transplants with non-Hodgkin lymphoma, there were significant declines over time in elevated risks for DCGF and DWFG but no significant changes for other combined cancers. For recipients transplanted in the most recent period (2007-2016), risks following cancer diagnosis remained high, with 38% experiencing DWFG and 14% graft failure within four years of diagnosis. Absolute risk of DWFG was especially high following lung cancer (78%), non-Hodgkin lymphoma (38%), melanoma (35%), and colorectal cancer (49%). Thus, across a 30-year period in the United States, there was no overall change in cancer incidence among recipients of kidney transplants. Despite improvements for non-Hodgkin lymphoma, cancer remains a major cause of morbidity and mortality.
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Cancer & Transplantation — comprehensive review series

Christopher D. Blosser
American Journal of Transplantation Supplement
Series Editorship

A curated series of invited reviews of topics related to cancer and transplantation published in the American Journal of Transplantation.

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Audio interview series on cancer in transplantation

Christopher D. Blosser, Germaine Wong, Tarek Alhamed, Scott Tykodi, Kirsten Wentlandt
American Journal of Transplantation
Interview

Dr. Christopher Blosser created and hosted a four-part series on cancer and organ transplant, covering unmet needs, cancer recurrence monitoring, immunotherapy, and palliative conversations with Drs. Germaine Wong, Tarek Alhamed, Scott Tykodi, and Kirsten Wentlandt.

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A call to action: the need for improved transplant cancer screening guidelines

Christopher D. Blosser
American Journal of Transplantation
Editorial
DOI: 10.1111/ajt.14034
PMID: 27589841

The increasing incidence of cancer in the aging U.S. population and longer-living transplant recipients requires updated contemporary cancer screening guidelines produced by relevant stakeholders using appropriate data and analytic techniques.

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