Cancer risk and mortality after kidney transplantation: a population-based study on differences between Danish centres using standard immunosuppression with and without glucocorticoids

Nephrol Dial Transplant. 2016 Dec;31(12):2149-2156. doi: 10.1093/ndt/gfw304. Epub 2016 Sep 1.


Background: Kidney recipients receive immunosuppression to prevent graft rejection, and long-term outcomes such as post-transplant cancer and mortality may vary according to the different protocols of immunosuppression.

Methods: A national register-based historical cohort study was conducted to examine whether post-transplant cancer and all-cause mortality differed between Danish renal transplantation centres using standard immunosuppressive protocols including steroids (Centres 2, 3, 4) or a steroid-free protocol (Centre 1). The Danish Nephrology Registry, the Danish Civil Registration System, the Danish National Cancer Registry and the Danish National Patient Register were used. A historical cohort of 1450 kidney recipients transplanted in 1995-2005 was followed up with respect to post-transplant cancer and death until 31 December 2011.

Results: Compared with Center 1 the adjusted post-transplant cancer risk was 6-39% lower in Centre 3 [hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.67-1.32], in Centre 2 (HR 0.72, 95% CI 0.52-0.98) and in Centre 4 (HR 0.61, 95% CI 0.44-0.83). Compared with Center 1, the adjusted post-transplant mortality was 21-55% higher in Centre 4 (HR 1.21, 95% CI 0.91-1.61), in Centre 3 (HR 1.35, 95% CI 0.98-1.86) and in Centre 2 (HR 1.55, 95% CI 1.17-2.05). On average, post-transplant cancer was associated with a 4-fold increase in the risk of death (HR 4.25, 95% CI 3.36-5.38).

Conclusions: There was a tendency of a higher post-transplant cancer occurrence, but lower all-cause mortality, in the Danish transplantation centre that adhered to a standard steroid-free immunosuppressive protocol.

Keywords: Danish national health registries; kidney transplantation; mortality; post-transplant cancer; steroids.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Cohort Studies
  • Denmark / epidemiology
  • Glucocorticoids / therapeutic use*
  • Graft Rejection / prevention & control
  • Humans
  • Immunosuppression Therapy
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation
  • Male
  • Middle Aged
  • Neoplasms / immunology
  • Neoplasms / mortality*
  • Proportional Hazards Models
  • Risk Factors
  • Young Adult


  • Glucocorticoids
  • Immunosuppressive Agents