We appreciate Professors Beaugerie and Peyrin-Biroulet’s interest in our study and their careful and thorough discussion of the potential caveats and context required to interpret our findings.1 We agree fully with the main premise in their letter, namely, that the decision to initiate immunosuppressive therapy may be biased by the characteristics of the initial cancer with a tendency toward earlier initiation in those considered to be at low risk for recurrence. We also appreciate their suggestion regarding the value of an external reference group.