Author Identifier (ORCID)
Abstract
Rationale & Objective: A cancer diagnosis is associated with complex risks for patients that may influence survival and access to transplantation. This study characterized the probability and timing of cancer-related death, noncancer death, and transplantation among patients with an incident cancer diagnosis after dialysis initiation. Study Design: Longitudinal cohort study. Setting & Participants: In Australia and New Zealand, 2000-2021, 3,052 patients receiving dialysis, identified via the Australia and New Zealand Dialysis and Transplant Registry, with cancer diagnosed after they had started dialysis. Exposure: Cancer, categorized by type and stage. Outcome: Transplantation as well as cancer-related death and noncancer death for the 5 most common cancer types. Analytical Approach: Parametric mixture competing risk models to estimate event probabilities and timing, stratified by age and cancer stage. Results: Among 3,052 dialysis patients with incident cancer followed for a median of 1.3 years after diagnosis, 1,245 died from cancer, 1,127 died from other causes, and 204 received a transplant. The most common cancers were lung (n = 396), colorectal (n = 323), prostate (n = 269), liver (n = 249), and kidney (n = 242). For localized/regional prostate, kidney, and colorectal cancers, the probability of cancer-related death ranged from 0.09 to 0.32 while the probability of noncancer death was higher, ranging from 0.32 to 0.73. In contrast, cancer-related death predominated in the setting of metastatic disease, with a median time to death of 0.1 years for lung and liver cancers. Among patients aged under 70 with localized or regional prostate cancer, the probability of transplantation was 0.60 (95% CI, 0.48-0.71), which exceeded that of cancer-related death, 0.09 (95% CI, 0.06-0.12), and noncancer death, 0.32 (95% CI, 0.23-0.41). Analogous probabilities for kidney cancer were 0.52 (95% CI, 0.43-0.60), 0.12 (95% CI, 0.09-0.16), and 0.36 (95% CI, 0.29-0.43). Among those under 70 years with localized/regional prostate, kidney, or colorectal cancers, the risk of cancer-related death fell below that of noncancer death within 1 year of diagnosis. Limitations: Data on cancer staging were incomplete, residual confounding, and potential outcome misclassification. Conclusions: Among patients receiving dialysis with a localized or regional cancer diagnosis, the risk of cancer-related death is low and may be exceeded by noncancer mortality within 1 year of the cancer diagnosis. These findings support consideration of earlier transplantation for some patients with cancer and highlight the need for individualized approaches to defining transplant eligibility. Plain-Language Summary: People receiving dialysis who develop cancer are often excluded from kidney transplantation because of concerns about cancer-related survival. However, it is unclear how often people with cancer on dialysis die from cancer itself, die from other causes, or receive a transplant. Using registry data from Australia and New Zealand, we examined outcomes after a cancer diagnosis among people already receiving dialysis. We found that for several common cancers diagnosed at an early stage, death from cancer was uncommon and often occurred less frequently than death from other causes. In younger patients with certain cancers, transplantation was more likely than cancer-related death. These findings support earlier and more individualized consideration of transplantation in selected patients with a cancer diagnosis.
Keywords
kidney transplantation, dialysis, cancer mortality, competing risks, cancer staging, survival outcomes
Document Type
Journal Article
Date of Publication
8-1-2026
ISSN
02726386
Volume
88
Issue
2
PubMed ID
42173347
Publication Title
American Journal of Kidney Diseases
Publisher
W.B. Saunders
School
School of Medical and Health Sciences
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
First Page
238
Last Page
249.e1
Recommended Citation
Gately, R., Engels, E. A., Sabanayagam, D., Teixeira-Pinto, A., Campbell, S., Hawley, C., Lim, W., & Wong, G. (2026). Transplantation and mortality as competing outcomes among patients on dialysis with newly diagnosed cancer: A longitudinal cohort study. American Journal of Kidney Diseases, 88(2), 238-249. https://doi.org/10.1053/j.ajkd.2026.03.041