Long-term allograft and patient outcomes of kidney transplant recipients with and without incident cancer - a population cohort study

Lim, Wai H.; Badve, Sunil V.; Wong, Germaine

doi:10.18632/oncotarget.20781

Cited by 20 publications

(27 citation statements)

References 17 publications

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“…As expected, the incidence of cancer after KT in our cohort was also increased compared to general population with a SIR of 1.81 in women and a non-significant 1.22 in men. These rates were lower than the ones described in previous studies with an incidence of cancer among KT recipients two to four-fold higher than those age and sex-matched individuals from general population [4, 14, 28–30, 35]. Despite that apparent difference with the previously published data, our results are quite similar to those found in the European population [28, 31].…”

Section: Discussioncontrasting

confidence: 74%

Gender differences in cancer risk after kidney transplantation

et al. 2019

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Kidney transplant (KT) recipients are at greater risk of developing some cancers than the general population. Moreover, cancer is the only cause of death that is currently increasing after kidney transplantation. We analyzed incidence, risk factors and characteristics of post-transplant malignancies (solid organ tumors and lymphoproliferative disorders) at our center in 925 KT recipients (1979-2014). Sex differences were particularly assessed. One hundred and eight patients (11.7%) developed solid organ tumors (76.9%) or lymphoma (23.1%). Twenty-one percent of patients who reached 20 years after KT developed cancer, with a median post-KT time to diagnosis of 7.4 years. Most common solid organs affected were lung (30.1%), prostate (10.8%), bladder (9.6%), and native kidney (7.2%). When analyzing standardized incidence ratios (SIR) by gender compared to the general population, relative risk was increased in women (SIR = 1.81; 95%CI, 1.28–2.45) but not significantly increased in men (SIR = 1.22; 0.95–2.52). Regarding specific types, gynecological (SIR = 11.6; 4.2–22.7) and lung (SIR = 10.0; 4.3–18.2) in women, and bladder (SIR = 16.3; 5.9–32.1) in men were the most affected locations. Thymoglobulin, a polyclonal antibody that has been used as an immunosuppressive agent in kidney transplantation over the last decades, was a significant risk factor for developing cancer in adjusted regression analysis [IRR = 1.62, 1.02–2.57; p = 0.041], and was associated with lower patient survival. Compared with the general population, the incidence of post-KT non-skin cancer is almost two-fold higher in women but not significantly higher in men. Lung is the most common solid organ affected. Thymoglobulin induction therapy is associated with a greater risk.

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Section: Discussioncontrasting

confidence: 74%

Gender differences in cancer risk after kidney transplantation

et al. 2019

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“…4,5,13 The adjusted hazard ratios for overall graft loss and death with a functioning graft are higher among kidney transplant patients with versus without a prior cancer. 59 Incident cancer after kidney transplantation is a significant risk factor for death in patients with a functioning graft, accounting for the majority of deaths in these patients.…”

Section: Prognosismentioning

confidence: 99%

Renal tumors in end‐stage renal disease: A comprehensive review

et al. 2018

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The incidence of end-stage renal disease has increased owing to the greater prevalence of patients with chronic kidney disease and diabetes mellitus. End-stage renal disease is usually accompanied by acquired cystic disease and is a risk factor for renal cell carcinoma. The present review discusses the etiology of renal cell carcinoma in end-stage renal disease patients, focusing on two unique renal cell carcinoma histological subtypes: acquired cystic disease-associated renal cell carcinoma and clear cell papillary renal cell carcinoma. Acquired cystic disease-associated renal cell carcinoma occurs almost exclusively in patients who underwent hemodialysis, especially long-term (>10 years) hemodialysis. Its histology is distinctive: a cribriform or sieve-like architecture with intra- or intracystic lumina; tumor cells containing abundant eosinophilic cytoplasm and large nuclei with prominent nucleoli; and most notably, calcium oxalate crystal deposition. Recognition of the crystals is critical for diagnosing acquired cystic disease-associated renal cell carcinoma. Acquired cystic disease-associated renal cell carcinoma typically has an indolent clinical course, except in cases with sarcomatoid components. Clear cell papillary renal cell carcinoma also has an indolent course (no cases involving metastasis have been reported to date), and its features resemble those of both clear cell renal cell carcinoma and papillary renal cell carcinoma. Unlike acquired cystic disease-associated renal cell carcinoma, which occurs only in end-stage renal disease patients, clear cell papillary renal cell carcinoma occurs in non-end-stage renal disease patients as well. Additional renal tumors in end-stage renal disease patients include anastomosing hemangiomas. Long-term hemodialysis worsens the prognosis of end-stage renal disease patients with renal cell carcinoma, regardless of its original histological subtype, presumably by inducing oxidative stress and sarcomatoid transformation.

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“…Epidemiological studies have consistently shown that patients with ESKD are at a greater risk of certain cancers and cancer‐related deaths, particularly those cancers likely to have viral (eg, cervical cancer), immune (eg, melanoma) or uraemia‐related aetiologies (eg, renal cancers), compared with the age‐matched general population . Other than uraemia or immunosuppression‐induced alterations in the immune system, poor adherence to age‐specific cancer screening and the likelihood that cancers are more aggressive at presentation are some of the additional risk factors that contribute to a higher risk of cancer mortality in patients with ESKD . The current recommendations regarding the treatment of patients with ESKD are largely extrapolated from clinical trials and guidelines adapted from both the general population and patients with CKD, with a summary of these recommendations published by each country (eg, http://www.cari.org.au) and global consensus (https://kdigo.org/guidelines).…”

Section: Cause‐specific Mortalitymentioning

confidence: 99%

Impending challenges of the burden of end‐stage kidney disease in Australia

Lim¹,

Johnson

McDonald

et al. 2019

Medical Journal of Australia

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Summary Sex and age‐specific incidence rates of patients with treated end‐stage kidney disease (ESKD) in Australia are comparable to those in European countries, but substantially lower compared with those in the United States, Canada and many Asian countries. The incidence rates of treated ESKD in Australia increase with advancing age; however, the incidence of ESKD is likely to be underestimated because a proportion of patients with ESKD (about 50%) remain untreated. Late referral to nephrologists has reduced over the past decade, temporally associated with improved ESKD recognition. However, late referral still occurs in one in five Australians with ESKD. One in two Australians with ESKD has diabetes, with up to 35% of cases directly attributed to diabetes. Mortality rates for patients with ESKD remain substantially higher compared with the age‐matched general population, although there has been a significant improvement in survival over time. Cardiovascular disease and cancer are the two most common causes of death in patients with ESKD.

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Long-term allograft and patient outcomes of kidney transplant recipients with and without incident cancer - a population cohort study

Cited by 20 publications

References 17 publications

Gender differences in cancer risk after kidney transplantation

Gender differences in cancer risk after kidney transplantation

Renal tumors in end‐stage renal disease: A comprehensive review

Impending challenges of the burden of end‐stage kidney disease in Australia

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