Incidence and Mortality of Renal Cell Carcinoma after Kidney Transplantation: A Meta-Analysis

Abstract

Background: The incidence and mortality of renal cell carcinoma (RCC) after kidney transplantation (KTx) remain unclear. This study's aims were (1) to investigate the pooled incidence/incidence trends, and (2) to assess the mortality/mortality trends in KTx patients with RCC. Methods: A literature search was conducted using the MEDLINE, EMBASE and Cochrane databases from inception through October 2018. Studies that reported the incidence or mortality of RCC among kidney transplant recipients were included. The pooled incidence and 95% CI were calculated using a random-effect model. The protocol for this meta-analysis is registered with PROSPERO; no. CRD42018108994. Results: A total of 22 observational studies with a total of 320,190 KTx patients were enrolled. Overall, the pooled estimated incidence of RCC after KTx was 0.7% (95% CI: 0.5–0.8%, I2 = 93%). While the pooled estimated incidence of de novo RCC in the native kidney was 0.7% (95% CI: 0.6–0.9%, I2 = 88%), the pooled estimated incidence of RCC in the allograft kidney was 0.2% (95% CI: 0.1–0.4%, I2 = 64%). The pooled estimated mortality rate in KTx recipients with RCC was 15.0% (95% CI: 7.4–28.1%, I2 = 80%) at a mean follow-up time of 42 months after RCC diagnosis. While meta-regression analysis showed a significant negative correlation between year of study and incidence of de novo RCC post-KTx (slopes = −0.05, P = 0.01), there were no significant correlations between the year of study and mortality of patients with RCC (P = 0.50). Egger's regression asymmetry test was performed and showed no publication bias in all analyses. Conclusions: The overall estimated incidence of RCC after KTX was 0.7%. Although there has been a potential decrease in the incidence of RCC post-KTx, mortality in KTx patients with RCC has not decreased over time.

Promises of Big Data and Artificial Intelligence in Nephrology and Transplantation

“…Those needs that are classified as unmet require provision of some ample spaces for the purpose of imagination in relation to leveraging the strength associated with big data, as well as relevant artificial intelligence (AI) to improve the overall status of patients with kidney diseases [25]. In this article, we discuss the big data concepts in nephrology, describe the potential use of AI in nephrology and transplantation, and also encourage researchers and clinicians to submit their invaluable research, including original clinical research studies [26][27][28][29][30], database studies from registries [31][32][33], meta-analyses [34][35][36][37][38][39][40][41][42][43][44], and artificial intelligence research [25,[45][46][47][48] in nephrology and transplantation. Table 1 demonstrates known and commonly used databases that have provided big data in nephrology and transplantation [49][50][51].…”

Tubulocystic Renal Cell Carcinoma of the Native Kidney in a Renal Transplant Recipient: A Rare Case Report

“…Renal transplant recipients have an increased risk (0.5–1.0%) of developing renal cancer when compared to those with ESRD (0.3%) and the general population (0.005%) [ 11 – 14 ]. The highest incidence of renal cancers occurs in the native kidney but may also occur in the renal allograft or even be transmitted from the donor [ 15 ].…”

“…Despite the increased frequency of renal cysts and RCC in patients with ESRD, there are no widely accepted screening protocols or lower interventional thresholds either before or following transplantation [ 11 , 22 , 23 ]. The lack of screening can be attributed to the relatively high mortality associated with ESRD and the fact that screening has not been shown to significantly increase life expectancy except when performed in younger patients.…”

Characteristics and Graft Survival of Kidney Transplant Recipients with Renal Cell Carcinoma

“…While the increased risk for RCC among transplant recipients has been well documented, consensus and guidelines for screening using demographic characteristics and comparative outcomes of KTRs with RCC are not well established. Chewcharat et al [5] in a meta-analysis found that mortality following RCC in KTRs was 15% at an average follow-up of 42 months. However, the studies used to compile this meta-analysis did not compare survival outcomes to matched controls [5].…”

“…Chewcharat et al [5] in a meta-analysis found that mortality following RCC in KTRs was 15% at an average follow-up of 42 months. However, the studies used to compile this meta-analysis did not compare survival outcomes to matched controls [5]. Karami et al [6] found that RCC risk was elevated in US renal transplant recipients with the following characteristics: African American, male, longer pretransplant dialysis treatment, certain induction agents, polycystic kidney disease, hypertensive nephrosclerosis, and vascular disease [6].…”