Polycystic Kidney Disease and Cancer after Renal Transplantation

Abstract

Autosomal dominant polycystic kidney disease (ADPKD), the most common form of polycystic kidney disease (PKD), is a disorder with characteristics of neoplasia. However, it is not known whether renal transplant recipients with PKD have an increased risk of cancer. Data from the Scientific Registry of Transplant Recipients, which contains information on all solid organ transplant recipients in the United States, were linked to 15 population-based cancer registries in the United States. For PKD recipients, we compared overall cancer risk with that in the general population. We also compared cancer incidence in PKD versus non-PKD renal transplant recipients using Poisson regression, and we determined incidence rate ratios (IRRs) adjusted for age, sex, race/ethnicity, dialysis duration, and time since transplantation. The study included 10,166 kidney recipients with PKD and 107,339 without PKD. Cancer incidence in PKD recipients was 1233.6 per 100,000 person-years, 48% higher than expected in the general population (standardized incidence ratio, 1.48; 95% confidence interval [95% CI], 1.37 to 1.60), whereas cancer incidence in non-PKD recipients was 1119.1 per 100,000 person-years. The unadjusted incidence was higher in PKD than in non-PKD recipients (IRR, 1.10; 95% CI, 1.01 to 1.20). However, PKD recipients were older (median age at transplantation, 51 years versus 45 years for non-PKD recipients), and after multivariable adjustment, cancer incidence was lower in PKD recipients than in others (IRR, 0.84; 95% CI, 0.77 to 0.91). The reason for the lower cancer risk in PKD recipients is not known but may relate to biologic characteristics of ADPKD or to cancer risk behaviors associated with ADPKD.

The Future of Polycystic Kidney Disease Research—As Seen By the 12 Kaplan Awardees

“…After multivariable adjustment, overall cancer incidence was found to be significantly lower in patients with ADPKD by about 16%-17%, suggesting that there is cancer protection associated with PKD. 46 This was also found to be true for ARPKD, in a study that examined the incidence of colon cancer in unaffected carriers of a recessive PKHD1 mutation. 47 The reason for the lower cancer risk in patients with ADPKD is not known, but may relate to biologic characteristics of ADPKD itself or to better cancer risk behaviors with these patients.…”

“…As such, we carried out an epidemiologic study to answer this question. 46 Data from the Scientific Registry of Transplant Recipients, which contains information on all solid organ transplant recipients in the United States, were linked to 15 populationbased United States cancer registries that included data on 50 different cancers. Cancer incidence was compared in PKD versus non-PKD renal transplant recipients, and incidence rate ratios adjusted for age, sex, race/ethnicity, dialysis duration, and time since transplantation were determined.…”

Apoptosis in Polycystic Kidney Disease: From Pathogenesis to Treatment

“…On the other hand, increased apoptosis in ADPKD may counteract hyperproliferation, which may prevent kidneys from progression of PKD into the renal cell carcinoma despite the high rate of epithelial cell proliferation. Recent retrospective study showed that cancer incidence was lower in PKD renal transplant recipients than in non-PKD renal transplant recipients (101). The exact mechanisms of the low cancer risk in PKD recipients are unclear, but may be associated with the increased apoptosis.…”

Adult Dominant Polycystic Kidney Disease (ADPKD)

“…First the findings were considered coincidental, but many case reports and case series have continued to support this hypothesis [7]. Some studies showed an incidence for RCC of up to 15% in surgically removed ADPKD kidneys, the majority of these tumours measuring less than 2 cm in size [7,10,11]. Table 1 Table 2: Literature Review, list of published ADPKD cases diagnosed with renal cell carcinoma (RCC).…”

“…In comparison to ADPKD, ESRD and its associated acquired renal cystic disease are well-established risk factors for RCC and have widely been accepted in the literature [11,14,15]. The prevalence of RCC in ESRD patients is significantly higher than the prevalence of sporadic RCC in the general population (by an estimated factor of 1000) [7].…”