Incidence of colorectal cancer in renal transplant recipients compared with the general population and inflammatory bowel disease: A population-based real-world cohort study.

Abstract

e15707 Background: Chronic immunosuppression following renal transplantation is associated with an increased risk of malignancy; however, the relative incidence of increased malignancy risk remains poorly defined. The relative incidence of colorectal cancer (CRC) among renal transplant recipients compared with both the general population and other high-risk groups remains poorly defined. We evaluated CRC incidence in renal transplant recipients relative to individuals without a solid organ transplantation history and to patients with inflammatory bowel disease (IBD). Methods: We conducted a retrospective cohort study using real-world data from the TriNetX US federated research network. Adult renal transplant recipients were identified using CPT (50360, 50365), ICD-10 (Z94.0), and ICD-10-PCS (0TY00Z0) codes. Two comparator cohorts were constructed: (1) individuals without solid organ transplantation, IBD (ICD-10 K50, K51), or family history of digestive malignancy (Z80.0), and (2) patients with IBD without prior transplantation. Patients with pre-existing CRC were excluded. Propensity score matching was not feasible due to limited cohort size. Incident CRC was defined using ICD-10 codes C18–C20 and evaluated with Cox proportional hazards models, reported as risk ratios (RRs) with 95% confidence intervals (CIs). Results: The final analytic cohort consisted of 166,422 renal transplant recipients, 596,934 patients with IBD, and 46,820,315 individuals in the general comparator cohort. During follow-up, renal transplant recipients demonstrated a significantly higher incidence of CRC compared with the general population Risk Ratio (RR 1.75, 95% Confidence Interval CI 1.63–1.87; p < 0.0001). In contrast, CRC incidence among renal transplant recipients was significantly lower than that observed in patients with IBD (RR 0.78, 95% CI 0.72–0.84; p < 0.0001). Subgroup analyses demonstrated that these associations were consistent across age categories, including younger adults (18–45 years) and older adults (45–80 years), with no meaningful attenuation of effect by age. Conclusions: In this large real-world cohort, renal transplant recipients exhibited an intermediate risk of CRC, with an incidence higher than that of the general population but lower than that of patients with IBD. These findings support the consideration of risk-stratified CRC screening strategies in transplant populations and provide real-world evidence to inform surveillance approaches in chronically immunosuppressed populations. Outcome General Population HR (95% CI) p Value Inflammatory Bowel Disease HR (95% CI) p Value Malignant neoplasms 1.75 (1.63–1.87) <0.0001 0.78 (0.72–0.84) <0.0001 Benign neoplasms 1.65 (1.61–1.68) <0.0001 0.61 (0.60–0.60) <0.0001 Colonoscopies 1.78 (1.75–1.80) <0.0001 0.37 (0.30–0.31) <0.0001