Improving the health outcomes of people after kidney transplantation

Abstract

For patients with end-stage kidney disease, kidney transplantation generally offers the best survival and quality of life. Complications such as cancer and cardiovascular disease are now the most important causes of morbidity and mortality in kidney transplant recipients past the initial post-transplant period. The overarching aim of this thesis was to improve our understanding of cancer in people after kidney transplantation. Chapter 2 provides a comprehensive literature review of the topic of cancer and kidney transplantation. Chapter 3 provides a review of the process of creating a risk prediction model, including an illustrative example. Prediction models may be applied to transplant recipients to predict the risk of experiencing an outcome, such as cancer. Chapters 4 and 5 were population-based registry studies using data from the Australia and New Zealand Dialysis and Transplant Registry. Chapter 4 demonstrated the greatly increased risk of cancer mortality in kidney transplant recipients, particularly in de novo cancers that arise after kidney transplantation. Chapter 5 explored the changes in cancer risk as patients progress through different treatment modalities for end-stage kidney disease, from dialysis to kidney transplantation to graft loss to subsequent kidney transplantation, and demonstrated increased risk of cancer after kidney transplantation, and reduction in cancer risk after loss of the first kidney transplant. In Chapter 6, data from the DETECT study was analysed and novel risk factors for advanced colorectal neoplasia in patients with chronic kidney disease, including patients on dialysis and kidney transplant recipients, were identified. Chapter 7 was a systematic review of trial registrations which demonstrated that cancer is an infrequently reported outcome and is inconsistently defined in trials of kidney transplant recipients, despite the importance of cancer as an outcome to kidney transplant recipients and other stakeholders.