Risk of colorectal cancer in kidney transplant recipients and patients with end-stage renal disease undergoing hemodialysis

Abstract

Background/Aims: Assessing the risk of colorectal cancer (CRC) after kidney transplantation (KT) in patients with endstage renal disease (ESRD) receiving dialysis is crucial to determine KT’s risks and benefits. In Korea, the study results remain unclear. Therefore, using a nationwide health screening and claims database, this longitudinal study aimed to investigate CRC risk in KT recipients versus patients with ESRD receiving hemodialysis. Methods: This research recruited 65,154 participants (60,202 on dialysis vs. 4,955 with KT) from the database of the Korean National Health Insurance Service, which provides mandatory health insurance to all Korean citizens. These participants were followed up from the baseline to CRC development, loss of follow-up, or study completion. The landmark method was used to effectively control the immortal time bias. Results: During the follow-up period, the incidence of CRC was 2.9 per 1,000 person-years in the dialysis group and 1.2 per 1,000 person-years in the KT group (p < 0.001). The mean time for CRC development in the dialysis and KT groups was 4.5 and 4.8 years, respectively. Compared with dialysis patients, the KT group obtained an adjusted hazard ratio of 0.54 for CRC (95% confidence interval, 0.42–0.71; p < 0.001). Landmark analysis showed that the 15-year cumulative CRC incidence was significantly higher in the dialysis group than in the KT group after landmark time points of 3 and 5 years (p < 0.0001). Conclusions: The risk of CRC after KT remained significantly lower than that of patients undergoing dialysis, even after landmark analysis.