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Renal cell cancer after kidney transplantation

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Abstract

Purpose

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.

Results

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.

Conclusions

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.

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Sources of financial support

This work was supported by a grant from the German Federal Ministry of Education and Research (reference number 01EO1302).

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Authors and Affiliations

  1. Department of General, Visceral and Transplant Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany

    Dennis Kleine-Döpke, Frank Lehner, Jürgen Klempnauer & Harald Schrem

  2. Department of Urology, St. Antonius Hospital, Gronau, Germany

    Matthias Oelke

  3. Department of Urology and Urological Oncology, Hannover Medical School, Hannover, Germany

    Matthias Oelke

  4. Department of Nephrology, Hannover Medical School, Hannover, Germany

    Anke Schwarz

  5. Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Facility Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany

    Ysabell Schwager & Harald Schrem

Authors
  1. Dennis Kleine-Döpke
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  2. Matthias Oelke
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  3. Anke Schwarz
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  4. Ysabell Schwager
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  6. Jürgen Klempnauer
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  7. Harald Schrem
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Contributions

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.

Corresponding author

Correspondence to Dennis Kleine-Döpke.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

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

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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Kleine-Döpke, D., Oelke, M., Schwarz, A. et al. Renal cell cancer after kidney transplantation. Langenbecks Arch Surg 403, 631–641 (2018). https://doi.org/10.1007/s00423-018-1694-x

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