Renal cell cancer after kidney transplantation
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This study aims to identify modifiable risk factors for de novo renal cell carcinoma (RCC) after kidney transplantation in a matched-pair approach matching for unmodifiable factors.
Patients and methods
One thousand six hundred fifty-five adults who underwent kidney transplantation in the period 1 January 2000 to 31 December 2012 were analyzed. Patients with RCC after kidney transplantation were matched in a 1:2 ratio with those without RCC using the indication for transplantation, age at transplantation (± 10 years), recipient sex (male/female), number of received transplants, living organ donor transplantation (yes/no), and time of follow-up in days as matching criteria. The paired t test was used to compare continuous variables and the Cochran-Mantel-Haenszel test for categorical variables. Multivariable conditional logistic regression modeling was used to identify independent risk factors for RCC.
In matched-pair analysis, a total number of 26 incident cases with RCC after kidney transplantation could be matched. Post-transplant RCC was significantly associated with longer durations of pre-transplant hemodialysis (p = 0.007) and post-transplant immunosuppression with cyclosporine (p = 0.029) and/or mycophenolate mofetil (p = 0.020) and with larger proportions of post-transplant time on mycophenolate mofetil (p = 0.046) and/or prednisolone medication (p = 0.042). Multivariable conditional logistic regression modeling revealed a significant risk increasing multiplicative factor interaction between the duration of pre-transplant dialysis (years) and the time of prednisolone usage (percent/100). Cyclosporine A usage and mycophenolate mofetil usage were also revealed as independent, significant risk factors for RCC development.
Longer pre-transplant dialysis, cyclosporine-based protocols and/or intensified immunosuppression with additional mycophenolate mofetil, and larger proportions of time of prednisolone treatment during follow-up increase de novo RCC risk.
KeywordsRenal cell cancer Renal transplantation Immunosuppression Hemodialysis Cyclosporine
Sources of financial support
This work was supported by a grant from the German Federal Ministry of Education and Research (reference number 01EO1302).
Study conception and design: Dennis Kleine-Döpke, Matthias Oelke, and Harald Schrem. Acquisition of data: Dennis Kleine-Döpke, Matthias Oelke, Ysabell Schwager, and Harald Schrem. Analysis and interpretation of data: Dennis Kleine-Döpke, Matthias Oelke, and Harald Schrem. Drafting of manuscript: Dennis Kleine-Döpke, Matthias Oelke, and Harald Schrem. Critical revision of manuscript: Dennis Kleine-Döpke, Matthias Oelke, Anke Schwarz, Ysabell Schwager, Frank Lehner, Jürgen Klempnauer, and Harald Schrem.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Ethics Committee of Hannover Medical School approved this retrospective study (approval decision number 2706-2015).
Informed consent was obtained from all individual participants included in the study. Patients provided informed consent that their data may be used for scientific purposes at the time of hospital admission which is the general policy of our institution.
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