대한신장학회

논문분류	춘계학술대회 초록집
제목	Post-Transplant Malignancy Drives Excess Mortality but Not Intrinsic Graft Failure After Kidney Transplantation: A Nationwide Competing Risk Analysis
저자	Jinsun Lee
출판정보	2026; 2026(1):
키워드	Post-transplant malignancy, Death-censored graft failure, Death with functioning graft, Mortality, Kidney transplantation
초록	Objectives: Post-transplant malignancy (PTM) is a recognized threat following kidney transplantation (KT), yet whether it differentially disrupts patient survival versus intrinsic allograft function remains undefined. We aimed to delineate the cause-specific burden of PTM on all-cause mortality, death with a functioning graft (DWFG), and death-censored graft failure (DCGF) in a nationwide cohort. Methods: Using the Korean National Health Insurance Service database, we identified adults who underwent KT between 2007 and 2023. PTM was modeled as a time-dependent exposure. Cause-specific Cox models assessed DCGF and DWFG under competing risks. Landmark analyses at 1, 3, and 5 years post-KT, trend analyses by time from KT to PTM, and subgroup analyses with tests for interaction were performed. Standardized mortality ratios (SMRs) and mortality rate ratios (MRRs) were calculated by cancer subtype, sex, and age. Results: Of 21,776 KT recipients (median follow-up 6.6 years), 1,898 developed PTM. PTM was strongly associated with all-cause mortality (aHR 4.41, 95% CI 3.69–5.28) and DWFG (aHR 4.90, 95% CI 4.04–5.95), yet showed no association with DCGF (aHR 1.03, 95% CI 0.73–1.46; p=0.861), suggesting that PTM claims the patient before the graft. This DWFG-dominant, DCGF-sparing dissociation persisted across landmark analyses at 1, 3, and 5 years post-KT. Mortality risk showed a significant increasing trend with later PTM occurrence (p for trend <0.001). The PTM-all-cause mortality association was more pronounced in younger recipients, desensitized recipients, and those with shorter pre-transplant dialysis duration. The overall SMR was 8.4, highest for central nervous system malignancies, non-Hodgkin lymphoma, and head and neck cancer. Conclusion: In the largest Korean nationwide KT cohort to date, PTM imposed a profound and selective burden on death-related outcomes while leaving intrinsic allograft integrity intact. Post-PTM care should prioritize survival-first strategies encompassing cancer subtype–specific surveillance, risk-stratified counseling, and heightened vigilance for late-onset PTM.
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