Transplant or dialysis: What’s the better choice for RCC-induced ESRD patients? A 20-year analysis of OPTN/UNOS data

Abstract

PurposeThe incidence of end-stage renal disease (ESRD) caused by renal cell carcinoma (RCC) is increasing with the high prevalence of RCC as well as those with treatment-related renal function impairment. Worries about tumor recurrence after transplant-related immunosuppression hinder the recommendation of kidney transplantation for RCC-induced ESRD patients. However, no direct analysis has been performed to identify whether kidney transplantation can offer better survival than maintaining dialysis.Materials and methodsThis retrospective population-based cohort study was based on Organ Procurement and Transplantation Network data released in March 2021. Characteristics and outcomes were compared, including the patient and graft survival of candidates and recipients with RCC-induced ESRD etiology as well as other primary diseases.ResultsPatients with RCC-induced ESRD were older; more likely to be male, White, and obese; and more likely to have a history of diabetes and dialysis. They also had higher creatinine levels, more delayed graft function, more primary non-function, and higher Kidney Donor Profile Index score donors, compared with the glomerulonephritis (GN) group. While waiting, RCC candidates suffered the worst outcomes of all groups, a 44% (adjusted hazard ratio [aHR], 1.44 [1.27–1.62]) higher risk of removal than GN patients. After transplantation, RCC recipients demonstrated comparable patient survival and better graft survival (p=0.21 and p=0.13, respectively). Compared with still-waiting RCC patients, the RCC recipients who received kidney transplants had significantly better outcomes (13.6 [9.3–17.8] vs. 61 [52–68.4] %), decreasing the death or deteriorating risk by 84% (aHR, 0.16 [0.13–0.20]).ConclusionsPatients with RCC-induced ESRD can dramatically benefit from kidney transplantation. Hence, these patients should not be limited to transplantation by strict strategies or a delayed waiting time out of their malignancy history.

Renal cell carcinoma of different pathological types in bilateral native kidneys of a kidney transplant recipient: A case report and literature review

“…Kidney transplantation improves survival and quality of life for patients with end-stage renal disease and is less expensive than countless dialysis sessions, making it the preferred form of kidney replacement therapy ( 3 , 4 ). Nevertheless, transplant recipients are at higher risk of developing malignancies and the renal cancer incidence is 6.8 times higher than that of the normal population due to long-term immunosuppression ( 5 , 6 ).…”

A Rare Case of Donor-Derived Renal Cell Carcinoma in a Kidney Transplant Recipient

“…RCC is rare in KTRs, accounting for only 0.2% of reported cases, and risk factors include older donor age, patient history of smoking, obesity, acquired cystic kidney disease (ACKD), and hypertension. Interestingly, KTRs who received a deceased donor transplant are associated with a higher incidence of allograft RCC [ 6 ]. This report presents a case of probable donor-derived RCC of the allograft diagnosed in the early post-transplantation period.…”