Using patient data to look at cancer after transplantation | Webinars

How can patient data help researchers to understand more about the risk of cancer in people who have had a solid organ transplant? 

On Tuesday 15th July, we hosted a webinar with guest speaker Adnan Sharif about the ongoing study 'Epidemiology of Cancer after solid Organ Transplantation (EpCOT)'.

The issue

Risk of cancer is a big concern for lots of people who have had a transplant, and is a topic that has been studied by researchers all over the world. Transplant patients can have an increased risk of cancer for a variety of reasons, such as having more inflammation in their body, taking immune suppression medication, and exposure to other risk factors like obesity. 

However, much of the existing research on this topic was conducted either a long time ago or in places other than the UK, so it can be difficult to translate findings to patients and practices within the UK. Many studies also show conflicting findings on things like the risk of dying from cancer, or whether older people are at higher risk.

The research

Researchers from Birmingham have been looking at data from over 85,000 people who received an organ transplant in the UK between 1985 and 2015 to develop a complete picture of the risk of cancer after transplantation. The data used in this study has come from the UK Transplant Registry, the National Death Registry, the Cancer Registry, and Hospital Episode Statistics. 

The webinar

Watch the webinar here 

Your submitted questions

Below are your submitted questions from the webinar, with answers provided by the speaker Adnan Sharif. 

It appears that general over-immunosuppression could have a direct link to cancer, and an indirect link by risk of infection. What are your thoughts on this?

While organ rejection rates have decreased due to improved anti-rejection medications, there has been a trade-off with increased infection and cancer risk. The challenge is finding the 'Goldilocks point' - the right balance of immunosuppression that is not too much (increasing risk of infections and cancers) or too little (increasing risk of rejection). Currently, there are no tools or tests to determine the optimal level for each patient, so it involves trial and error. However, there is a growing focus on personalised immunosuppression, rather than giving every patient the same treatment package.

Will you be looking at cancer risk combined with different immunosuppression dosages in your study?

Unfortunately, this cannot be studied on a national scale because the data doesn't exist in a comprehensive dataset. NHS Blood and Transplant (NHSBT) has some data on immunosuppression, but it is not a complete dataset because it is not a mandatory field for healthcare professionals to fill in. However, individual hospitals could conduct studies on this topic in the future using their own patient data.

Do you have any information about acitretin (a medication taken by some transplant patients)?

Acitretin is a medication used quite a lot by dermatologists and is taken by some transplant patients to prevent skin cancer. There is no good evidence regarding its impact on other types of cancers, or specifically in transplant patients. This study won't be able to answer questions about this specific medication due to lack of information in available datasets. 

Is there any data about radiation exposure from X-ray scans and the potential cancer risk?

There is no transplant-specific data for this. In the general population, environmental factors like frequent flights or multiple scans with cumulative radiation exposure can increase cancer risk. This risk must be balanced against the necessary scans required to care for transplant patients. Modern radiologists are aware of the cancer risk and use the lowest possible exposure levels.