Cancer treatment outcomes in solid organ transplant recipients: a single-center retrospective cohort study

Abstract

Solid organ transplant recipients are at increased risk of de novo malignancies but are rarely included in prospective oncology trials, leaving their optimal cancer management poorly defined. We evaluated the treatment, tolerability, and outcomes of de novo solid cancers in transplant recipients treated at a single tertiary center. We retrospectively analyzed 39 transplant recipients (27 kidney, 11 liver, 1 heart) diagnosed with de novo solid cancers between 2012 and 2022. Data on demographics, transplant and tumor characteristics, treatment, toxicity, graft outcomes, and survival were collected. Overall survival (OS) was estimated by the Kaplan–Meier method, and univariable associations were assessed using the log-rank test and Cox proportional hazards models. The cohort had a median age of 57 years, and 16 patients (41.0%) had stage IV disease at diagnosis. Twenty-two patients (56.4%) received systemic therapy, most commonly cytotoxic chemotherapy. Grade 3–4 toxicity occurred in 10 of these patients (45.5%), mainly hematological or infective, and seven (31.8%) experienced treatment delays. Graft dysfunction was recorded in four patients (10.3%), three of whom had stage IV disease; no episode of acute rejection attributable to systemic therapy was documented. After a median follow-up of 40 months, 19 patients (48.7%) had died; the median OS was 27.0 months (95% CI, 11.9–42.1). Disease progression was the leading cause of death (63.2%), while infection contributed to approximately a quarter of all deaths (26.3%). On univariable analysis, stage IV disease (HR 9.82; 95% CI, 3.00–32.13) and ECOG performance status 2–3 (HR 6.29; 95% CI, 2.37–16.67) were associated with shorter survival, although the small number of events limits the precision of these estimates. In this small and clinically heterogeneous cohort, de novo solid cancers in transplant recipients were frequently diagnosed at an advanced stage and carried a poor prognosis, with stage and performance status showing the strongest associations with survival. Systemic treatment was feasible but often poorly tolerated. These exploratory findings suggest that anticancer therapy should be delivered with careful multidisciplinary management rather than withheld, but they require confirmation in larger, multicentre cohorts.