Cancer Risk in Living Kidney Donors

Note: Data on donors were included from the following cancer registries: Alaska, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kentucky, Louisiana, Michigan, Montana, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, Texas, Utah, and Virginia. Donors were included from the following states/territories that provided cancer registry data: Alaska, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kentucky, Louisiana, Michigan, Montana, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, Texas, Utah, and Virginia. Abbreviations: AHS-2, Adventist Health Study 2.
^aMissing data are excluded from the percentage calculations. Data on donor relationship to transplant recipient were missing for 75 living kidney donors. Data on education were missing for 27,585 donors and 512 AHS-2 participants. Data for donors were missing for body mass index (N = 21,404, mostly for donations before 2001, so results are restricted to 2001 and after), hepatitis B surface antigen (N = 9759), and hepatitis C virus antibody (N = 8683). Data for tobacco use were not collected on donors before 2006; results for donors are presented for 2006–2017. AHS-2 did not collect information on hepatitis B and C infection.
^bObesity was defined based on a body mass index greater than 30 kg/m².

Note: Standardized incidence ratios incorporate a calculation of the expected number of cancer cases, based on SEER cancer registry data and stratification of rates by sex, age, race/ethnicity, and calendar year.
Abbreviations: HPV human papillomavirus, SIR standardized incidence ratio.

Note: Statistically significant incidence rate ratio estimates are underlined.
Abbreviations: AHS,-2 Adventist Health Study 2; CI, confidence interval; IRR, incidence rate ratio.
^aCounts of kidney cancer reflect the presence of 1 kidney in donors and 2 kidneys in AHS-2 participants. The IRR calculations adjust for this difference in the number of kidneys per person (see Methods).
^bIncidence rate ratios compare incidence in donors with AHS-2 participants, that is, IRR > 1 implies greater incidence in donors. Multivariable models are adjusted for sex, attained age (ordinal variable using 5-year categories from 30–34 to 85+ years), race/ethnicity, and US region. The multivariate model for liver cancer did not converge, and the p-value shown in the multivariable adjusted model results is instead from the age-adjusted model. The multivariate model for melanoma did not converge, and the results are shown from a model without US region.

Authors and Disclosures

Eric A. Engels¹, Gary E. Fraser², Bertram L. Kasiske³, Jon J. Snyder³, Jason Utt⁴, Charles F. Lynch⁵, Jie Li⁶, Karen S. Pawlish⁶, Sandra Brown¹, Kelly J. Yu¹ and Ruth M. Pfeiffer<sup>1

1</sup>Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
²School of Public Health, Loma Linda University, Loma Linda, California, USA
³Scientific Registry of Transplant Recipients, Minneapolis, Minnesota, USA
⁴Research Affairs, Loma Linda University, Loma Linda, California, USA
⁵Department of Epidemiology, The University of Iowa, Iowa City, Iowa, USA
⁶Department of Health, Cancer Epidemiology Services, Trenton, New Jersey, USA

Correspondence
Eric A. Engels, Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr, Room 6E226, Bethesda, MD 20892 USA. Email: engelse@exchange.nih.gov

Disclosure
The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.