Establishing a cohort to study cancers in organ transplant recipients

In 2012, a total of 28,053 organ transplants were performed in the United States. Although organ transplant is a life-saving therapy, organ transplant recipients experience serious adverse health outcomes including increased risk for various cancers. Through data linkage between population-based transplant registries and cancer registries, large studies have characterized the spectrum and patterns of cancer risk in organ transplant recipients. However, due to limitations in the types and quality of information collected in population-based registries, studies using registry data often do not account for factors such as immunosuppressive medication dosing or regime change, comorbidities (e.g., hepatitis B or hepatitis C infection), and other cancer risk factors (e.g., smoking history, history of cancer). In addition, information on cancer screening practices in organ transplant recipients is very limited in registry data, even though screening practices have been hypothesized to affect cancer risk in this population. By contrast, integrated health care systems such as health plans in the Cancer Research Network (CRN) are uniquely positioned to fill in the knowledge gaps that cannot be fully addressed in registry-based studies. The goal of the proposed pilot study is to use Kaiser Permanente Southern California (KPSC) as the primary study site for establishing a cohort of transplant recipients to study incident cancers in this high risk population, with the intention of expanding this effort to other CRN sites. At KPSC, there are existing organ transplant registries that can be used to identify organ transplant recipients. The study will first link KPSC transplant registry data with clinical and administrative health plan data in order to describe transplant recipients’ sociodemographic characteristics, immunosuppressive medication use, comorbidities, cancer incidence, health care utilization, and survival. The study will then develop and validate health plan data-based algorithms for identifying patients undergoing organ transplant. These algorithms will be useful for identifying transplant recipients at CRN sites that do not currently have infrastructure to capture transplant recipients. Lastly, a survey will be conducted across all CRN sites in order to characterize the types and quality of transplant data available at each site. Knowledge gained from this pilot study will enable future R01-level applications examining cancer risks associated with immunosuppressive medications, comorbidities, and cancer screening practices in transplant recipients. This study fits the interests of the Prevention & Screening Scientific Working Group of the CRN

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