#540 Cancer screening examination can decrease the death with the functioning graft after living donor kidney transplantation

Abstract Background and Aims The immunosuppressive (IS) medication is essential for the long-term graft survival. However, death with the functioning graft (DWFG) due to cancer after kidney transplantation (KT) can be caused by administration of IS medications and can shorten the graft survival. Method The effectiveness of cancer screening examination after living donor KT to decrease DWFG was investigated in this single center retrospective cohort study including 1274 living donor KTs between January 2008 and December 2021. Cancer before graft failure was identified in 141 recipients. The impact of the cancer screening examination on DWFG was investigated in recipients classified into three groups; recipients with cancer detected through screening examinations, with cancer detected incidentally or symptomatically, and without cancer using time dependent Cox regression analysis. Results DWFG-free survival rate in recipients without cancer was significantly higher than that in those with cancer detected through screening examinations (P < 0.001, HR 6.710) and recipients with cancer detected incidentally or symptomatically (P < 0.001, HR 14.731). A significant difference was identified in DWFG-free survival between recipients with cancer detected through screening examinations and those with cancer detected incidentally or symptomatically (P = 0.040, HR 2.195) (Fig. 1). Conclusion Cancer screening examination could help prevent DWFG associated with cancer.