Risk Factors for Renal Cancer Formation After Kidney Transplantation
German authors in the below-cited work identified modifiable risk factors associated with the development of renal cell carcinoma (RCC) de novo in patients after kidney transplantation.
Methodology of Analysis and Evaluated Data
Researchers analyzed data from 1655 patients who underwent kidney transplantation between 2000 and 2012 at the university hospital in Hannover, Germany. For patients who were found to have de novo RCC after transplantation, they identified control individuals in a 1:2 ratio who did not develop RCC after transplantation but matched the patients with RCC in terms of transplantation indication, age at the time of transplantation, recipient gender, number of transplants performed, living donor transplantation, and length of follow-up. Statistical methods used included paired t-test for comparing continuous variables, Cochran-Mantel-Haenszel test for comparing categorical variables, and multivariate logistic regression to identify independent risk factors for the development of RCC.
Results
De novo RCC was observed in 26 patients for whom matching controls could be found. Higher risk of RCC after transplantation was associated with longer duration of hemodialysis prior to transplantation (p = 0.007), administration of cyclosporine A (p = 0.029) or mycophenolate mofetil (p = 0.020) as immunosuppressive therapy after transplantation, and a greater proportion of time post-transplant on mycophenolate mofetil (p = 0.046) or prednisolone (p = 0.042). Significant independent risk factors for the development of RCC after transplantation identified by multivariate analysis included the duration of hemodialysis prior to transplantation, duration of prednisolone use, and administration of cyclosporine A or mycophenolate mofetil.
Conclusion
Independent risk factors for the development of RCC in patients after kidney transplantation include extended hemodialysis prior to transplantation, immunosuppression with cyclosporine A, intensified immunosuppression with the addition of mycophenolate mofetil, and longer duration of prednisolone administration during follow-up.
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Source: Kleine-Döpke D., Oelke M., Schwarz A. et al. Renal cell cancer after kidney transplantation. Langenbecks Arch Surg 2018; 403 (5): 631−641, doi: 10.1007/s00423-018-1694-x.
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