Risk of Renal Cell Carcinoma Among Kidney Transplant Recipients in the United States

• Published in: American journal of transplantation Vol. 16; no. 12; pp. 3479 - 3489
• Main Authors: Karami, S., Yanik, E. L., Moore, L. E., Pfeiffer, R. M., Copeland, G., Gonsalves, L., Hernandez, B. Y., Lynch, C. F., Pawlish, K., Engels, E. A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01-12-2016
• Subjects: Adult; cancer/malignancy/neoplasia: risk factors; Carcinoma, Renal Cell - epidemiology; Carcinoma, Renal Cell - etiology; Dialysis; epidemiology; Female; Follow-Up Studies; Glomerular Filtration Rate; Graft Rejection - epidemiology; Graft Rejection - etiology; Health risk assessment; health services and outcomes research; Humans; Immunology; Incidence; Kidney cancer; Kidney diseases; Kidney Failure, Chronic - surgery; Kidney Function Tests; Kidney Neoplasms - epidemiology; Kidney Neoplasms - etiology; Kidney transplantation; Kidney Transplantation - adverse effects; kidney transplantation/nephrology; Kidney transplants; Male; Middle Aged; Postoperative Complications; Prognosis; Renal cell carcinoma; Risk Factors; Transplants & implants; United States - epidemiology; United States > US; cancer/malignancy/neoplasia: risk factors; epidemiology; kidney transplantation/nephrology; health services and outcomes research
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/ajt.13862

Renal cell carcinoma (RCC) is a common malignancy following kidney transplantation. We describe RCC risk and examine RCC risk factors among US kidney recipients (1987–2010). The Transplant Cancer Match Study links the US transplant registry with 15 cancer registries. Standardized incidence ratios (SIRs) were used to compare RCC risk (overall and for clear cell [ccRCC] and papillary subtypes) to the general population. Associations with risk factors were assessed using Cox models. We identified 683 RCCs among 116 208 kidney recipients. RCC risk was substantially elevated compared with the general population (SIR 5.68, 95% confidence interval 5.27–6.13), especially for papillary RCC (SIR 13.3 versus 3.98 for ccRCC). Among kidney recipients, RCC risk was significantly elevated for blacks compared to whites (hazard ratio [HR] 1.50) and lower in females than males (HR 0.56). RCC risk increased with prolonged dialysis preceding transplantation (p‐trend < 0.0001). Risk was variably associated for RCC subtypes with some medical conditions that were indications for transplantation: ccRCC risk was reduced with polycystic kidney disease (HR 0.54), and papillary RCC was increased with hypertensive nephrosclerosis (HR 2.02) and vascular diseases (HR 1.86). In conclusion, kidney recipients experience substantially elevated risk of RCC, especially for papillary RCC, and multiple factors contribute to these cancers.
Kidney recipients have an elevated risk of developing renal cell carcinoma that is related to the duration of prior dialysis and the nature of the specific kidney diseases indicating transplantation.