Department of Medicine, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Wisconsin, Madison, Wisconsin, USA.
Department of Surgery, Division of Transplant Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Am J Nephrol. 2020;51(10):777-785. doi: 10.1159/000510616. Epub 2020 Sep 30.
The incidence of renal cell carcinoma (RCC) is higher in kidney transplant recipients (KTRs) compared to the general population. However, the risk factors and outcomes based on the diagnosis of RCC after kidney transplantation are limited.
We analyzed risk factors for the development of RCC in KTRs transplanted at our institution between 1994 and 2016. We compared the incidence of graft failure and mortality in KTRs with RCC to matched controls using 5:1 event density sampling. Identifying the risk factors of RCC and patient and graft survival were outcomes of interest.
There were 4,178 KTRs performed at our institution during the study period, and 51 patients were diagnosed with RCC. Recipients were followed until graft failure or death. We did not identify commonly looked at baseline characteristics associated with the risk of RCC. Comparing KTRs with RCC to matched controls, RCC patients were younger (47.5 vs. 49.6 years, p < 0.01), received basiliximab induction more commonly (p = 0.01), had hypertension and glomerulonephritis as causes of end-stage renal disease (p = 0.01), and were more likely to be smokers (p < 0.01). RCC was significantly associated with death-censored graft failure (adjusted hazard ratio [HR]: 1.76; 95% CI: 1.02-3.03; p = 0.04) but not patient death (adjusted HR: 0.95; 95% CI: 0.50-1.83; p = 0.89).
In our experience, RCC had a detrimental impact on graft survival among KTRs, highlighting the potential benefit of early diagnosis and optimal immunosuppression management in optimizing graft survival.
与普通人群相比，肾移植受者（KTR）的肾细胞癌（RCC）发病率更高。然而，基于肾移植后 RCC 的诊断，其风险因素和结果是有限的。
我们分析了 1994 年至 2016 年期间在我们机构接受移植的 KTR 中 RCC 发展的风险因素。我们使用 5:1 事件密度抽样法，将 RCC 的 KTR 与匹配对照者的移植物衰竭和死亡率进行比较。确定 RCC 的风险因素以及患者和移植物的生存是我们关注的结果。
在研究期间，我们机构共进行了 4178 例 KTR，其中 51 例被诊断为 RCC。受者随访至移植物衰竭或死亡。我们没有发现与 RCC 风险相关的常见基线特征。与匹配对照者相比，RCC 患者更年轻（47.5 岁比 49.6 岁，p < 0.01），更常接受巴利昔单抗诱导（p = 0.01），高血压和肾小球肾炎作为终末期肾病的病因（p = 0.01），并且更可能是吸烟者（p < 0.01）。RCC 与死亡风险校正的移植物衰竭显著相关（调整后的危险比 [HR]：1.76；95%CI：1.02-3.03；p = 0.04），但与患者死亡无关（调整后的 HR：0.95；95%CI：0.50-1.83；p = 0.89）。
根据我们的经验，RCC 对 KTR 的移植物存活率有不利影响，这突出了早期诊断和优化免疫抑制管理在优化移植物存活率方面的潜在益处。
