Time trends in risk and risk determinants of non-Hodgkin lymphoma in solid organ transplant recipients

P Fernberg, G Edgren, J Adami, A Ingvar, R Bellocco, G Tufveson, P Höglund, A Kinch, J F Simard, E Baecklund, B Lindelöf, Y Pawitan, K E Smedby

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36 Citations (SciVal)


Organ transplantation increases risk of non-Hodgkin lymphoma (NHL), but long-term risk and time trends have seldom been evaluated. Immunosuppressive drug load is an important risk determinant, but the details are unclear. We studied NHL risk in a nationwide Swedish cohort of 11 081 graft recipients transplanted 1970-2008. Relative risks (RRs) were estimated within the cohort and versus the general population by age, sex, follow-up time and calendar period. NHL risk was also assessed by cumulative and average doses of immunosuppressive treatments in a nested case-control design throughout 1997 using conditional logistic regression. We observed 153 NHL cases during 97 853 years of follow-up. Compared with the general population, NHL risk was eightfold increased (RR 7.9; 95% confidence interval [CI] 6.6-9.4), and increased risks persisted after ≥15 years of follow-up among kidney (6.1; 95% CI 3.5-10) and nonkidney recipients (44; 14-103). Among nonkidney recipients, NHL risk was lower in the 2000s compared with the 1990s (0.5; 95% CI 0.3-1.0; p = 0.04). A high average dose of antithymocyte immunoglobulin (ATG) conferred an eightfold increased risk of NHL (OR 8.5; 95% CI 1.9-38). To conclude, posttransplant NHL risk decreased during the last decade among nonkidney recipients, possibly because of a more careful use of ATG, the introduction of new drugs, or both.

Original languageEnglish
Pages (from-to)2472-82
Number of pages11
JournalAmerican Journal of Transplantation
Issue number11
Publication statusPublished - 2011 Nov
Externally publishedYes

Subject classification (UKÄ)

  • Clinical Medicine


  • Adolescent
  • Adult
  • Aged
  • Antilymphocyte Serum/adverse effects
  • Case-Control Studies
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Immunosuppressive Agents/therapeutic use
  • Kidney Transplantation/adverse effects
  • Lymphoma, Non-Hodgkin/epidemiology
  • Male
  • Middle Aged
  • Risk
  • Sweden/epidemiology
  • T-Lymphocytes/immunology
  • Transplants/adverse effects


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