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Zwald FO, Sargen MR, Austin AA, Hsieh MC, Pawlish K, Li J, Lynch CF, Yu KJ, Engels EA. Outcomes in solid organ transplant recipients with a pretransplant diagnosis of melanoma. Am J Transplant 2024; 24:993-1002. [PMID: 38387619 PMCID: PMC11144558 DOI: 10.1016/j.ajt.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
Melanoma causes significant morbidity in solid organ transplant recipients (SOTRs). Melanomas diagnosed before transplantation can recur with intensive immunosuppression, but outcomes have not been well studied. We evaluated 901 non-Hispanic White SOTRs with a pretransplant melanoma identified using linked transplant and cancer registry data in the United States. Most pretransplant melanomas were invasive (60.7%), and the median time from diagnosis to transplantation was 5.1 years. After transplantation, 41 SOTRs developed a new invasive melanoma, corresponding to 9-fold increased risk compared with the general population (standardized incidence ratio, 9.2; 95% confidence interval [CI], 6.6-12). Twenty-two SOTRs died from melanoma after transplantation, corresponding to 52-fold increased risk (standardized mortality ratio, 52; 95% CI, 33-79). Risk factors for posttransplant melanoma included age at transplantation (adjusted hazard ratio [HR], 2.86; 95% CI, 1.24-6.60; for age 55+ vs <55 years) and maintenance immunosuppression with cyclosporine/azathioprine (adjusted HR, 2.53; 95% CI, 1.08-5.90). Melanoma mortality was strongly elevated after a posttransplant melanoma diagnosis (HR, 35.6; 95% CI, 14.0-90.4; adjusted for cyclosporine/azathioprine maintenance therapy and calendar year of transplantation). In conclusion, SOTRs with a pretransplant melanoma are at risk of adverse melanoma-related outcomes after transplantation. These findings support thorough dermatologic evaluation prior to transplantation and frequent posttransplant surveillance.
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Affiliation(s)
- Fiona O Zwald
- Department of Dermatology, University of Colorado, Aurora, Colorado, USA
| | - Michael R Sargen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | | | - Mei-Chin Hsieh
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Karen Pawlish
- New Jersey Department of Health, New Jersey State Cancer Registry, Trenton, New Jersey, USA
| | - Jie Li
- New Jersey Department of Health, New Jersey State Cancer Registry, Trenton, New Jersey, USA
| | - Charles F Lynch
- Department of Epidemiology, The University of Iowa, Iowa City, Iowa, USA
| | - Kelly J Yu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Eric A Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
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Eule CJ, Hu J, Hedges D, Jani A, Pshak T, Manley BJ, Sanchez A, Dreicer R, Myint ZW, Zakharia Y, Lam ET. Clinical and Genomic Features of Patients with Renal Cell Carcinoma and Advanced Chronic Kidney Disease: Analysis of a Multi-Institutional Database. Cancers (Basel) 2024; 16:1920. [PMID: 38791999 PMCID: PMC11119962 DOI: 10.3390/cancers16101920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 04/30/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Patients with advanced chronic kidney disease (ACKD) are at an increased risk of developing renal cell carcinoma (RCC), but molecular alterations in RCC specimens arising from ACKD and overall survival (OS) in affected patients are not well defined. PATIENTS AND METHODS Using the Oncology Research Information Exchange Network (ORIEN) Total Cancer Care® protocol, 296 consented adult patients with RCC and somatic tumor whole exome sequencing were included. Patients with ACKD were defined as those with serum creatinine ≥1.5 mg/dL prior to RCC diagnosis. RESULTS Of 296 patients with RCC, 61 met the criteria for ACKD. The most common somatic mutations in the overall cohort were in VHL (126, 42.6%), PBRM1 (102, 34.5%), and SETD2 (54, 18.2%). BAP1 had a decreased mutational frequency in RCC specimens from patients without ACKD as compared to those with ACKD (10.6% versus 1.6%), but this was not statistically significant in univariable (OR 0.14, p = 0.056) or multivariable (OR 0.15, p = 0.067) analysis. Median OS was not reached in either cohort. CONCLUSIONS Using the clinicogenomic ORIEN database, our study found lower rates of BAP1 mutations in RCC specimens from patients with ACKD, which may reflect a BAP1-independent mutational driver of RCC in patients with ACKD.
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Affiliation(s)
- Corbin J. Eule
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Junxiao Hu
- Biostatistics Core, University of Colorado Cancer Center, Aurora, CO 80045, USA
| | | | - Alkesh Jani
- Division of Nephrology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - Thomas Pshak
- Division of Urology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Brandon J. Manley
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Alejandro Sanchez
- Division of Urology, Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA
| | - Robert Dreicer
- Division of Medical Oncology, Department of Medicine, University of Virginia Comprehensive Cancer Center, Charlottesville, VA 22908, USA
| | - Zin W. Myint
- Division of Medical Oncology, Department of Internal Medicine, Markey Cancer Center, University of Kentucky, Lexington, KY 40506, USA
| | - Yousef Zakharia
- Division of Hematology, Oncology, and Blood and Bone Marrow Transplantation, Department of Internal Medicine, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA 52242, USA
| | - Elaine T. Lam
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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Srisuwarn P, Sutharattanapong N, Disthabanchong S, Kantachuvesiri S, Kitiyakara C, Phakdeekitcharoen B, Ingsathit A, Sumethkul V. Incidence of De Novo Post-Transplant Malignancies in Thai Adult Kidney Transplant Recipients: A Single-Center, Population-Controlled, Retrospective Cohort Study at the Highest Volume Kidney Transplant Center in Thailand. Transpl Int 2024; 37:11614. [PMID: 38468637 PMCID: PMC10926888 DOI: 10.3389/ti.2024.11614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/14/2024] [Indexed: 03/13/2024]
Abstract
Kidney transplant recipients (KTRs) are at increased risk of developing de novo post-transplant malignancies (PTMs), with regional differences in types with excess risk compared to the general population. A single-center, population-controlled, retrospective cohort study was conducted at a tertiary care center in Thailand among all adults who underwent their first kidney transplant from 1986 to 2018. Standardized incidence ratios (SIRs) of malignancy by age, sex, and place of residence were obtained using data from the National Cancer Registry of Thailand as population control. There were 2,024 KTRs [mean age, 42.4 years (SD 11.4); female patients, 38.6%] during 16,495 person-years at risk. Of these, 125 patients (6.2%) developed 133 de novo PTMs. The SIR for all PTMs was 3.85 (95% CI 3.22, 4.56), and for pooled solid and hematologic PTMs, it was 3.32 (95% CI 2.73, 3.99). Urothelial malignancies had the largest excess risk, especially in women [female SIR 114.7 (95% CI 66.8, 183.6); male SIR 17.5 (95% CI 8.72, 31.2)]. The next two most common cancers were non-Hodgkin's lymphoma and skin cancer [SIR 20.3 (95% CI 13.6, 29.1) and 24.7 (95% CI 15.3-37.8), respectively]. Future studies are needed to identify the risk factors and assess the need for systematic screening among PTMs with excess risk in KTRs.
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Affiliation(s)
- Praopilad Srisuwarn
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Napun Sutharattanapong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Excellence Center for Organ Transplantation, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sinee Disthabanchong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Surasak Kantachuvesiri
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Excellence Center for Organ Transplantation, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chagriya Kitiyakara
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Bunyong Phakdeekitcharoen
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Atiporn Ingsathit
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Excellence Center for Organ Transplantation, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vasant Sumethkul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Jiang F, Wang F, Zhang T, Dong H, Bai H, Chen L. Current Trends and Future Directions of Malignancy After kidney Transplantation: A 1970-2022 Bibliometric Analysis. Ann Transplant 2024; 29:e942074. [PMID: 38163947 PMCID: PMC10771012 DOI: 10.12659/aot.942074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Malignancy after kidney transplantation (MKT) remains a leading cause of death in transplant recipients and over the past few decades there have been many reports on this topic. However, the task of extracting crucial information from intricate events poses a significant challenge in guiding clinical work. Hence, bibliometrics was employed to summarize and predict the future in this study. MATERIAL AND METHODS Reviews and articles on MKT were extracted from the Web of Science Core Collection (WoSCC) and were analyzed by the software VOSviewer, CiteSpace, Scimago Graphica, and R package Bibliometrix for bibliometric analysis. RESULTS The analysis considered 5700 publications from 28 647 authors and 4924 institutions across 100 countries, spanning the years 1970-2022. Reference co-citation analysis showed that "renal cell carcinoma", "skin cancer", "post-transplant lymphoproliferative disorder" and "COVID-19 vaccine" were research hotspots. Keywords that co-occurred early were "immunosuppressant", "cancer", "Epstein-Barr virus", "squamous cell carcinoma", and "infection", etc., while "impact","risk factor", "outcomes", "mortality", "management" frequently co-occurred later. From 2020 to 2022, newly emerging keywords such as "SARS-CoV-2" and "COVID-19", together with citation bursts for "immune checkpoint inhibitors" and "ipilimumab," were observed. CONCLUSIONS The focus of MKT-related studies has evolved from exploring the spectrum, risk factors, and outcomes of MKT, to examining the pathogenesis, individualized screening, prevention, and treatment, including appropriate use of immune checkpoint inhibitors. Reports of renal transplant recipients infected with SARS-CoV-2 or COVID-19 have also gained attention since 2019. These suggest that individualized management remains a frontier for research and a future direction in MKT topics.
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Affiliation(s)
- Fan Jiang
- Department of Urology, The Eighth Medical Center, Chinese PLA General Hospital, Beijing, PR China
- Section of Health, No. 94804 Unit of the Chinese People’s Liberation Army, Shanghai, PR China
- Resident Standardization Training Cadet Corps, Air Force Hospital of Eastern Theater, Nanjing, Jiangsu, PR China
| | - Fang Wang
- Department of Disease Prevention and Control, The Eighth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Tianyu Zhang
- Department of Urology, The Eighth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Hongmei Dong
- Department of Urology, The Eighth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Hongwei Bai
- Department of Urology, The Eighth Medical Center, Chinese PLA General Hospital, Beijing, PR China
| | - Liping Chen
- Department of Urology, The Eighth Medical Center, Chinese PLA General Hospital, Beijing, PR China
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Ferrari K, Aarnink A, Ayav C, Frimat L, Couchoud C, Audry B, Antoine C, Girerd S. Evolution of HLA-sensitization according to immunosuppressive therapy management among kidney transplant patients returning to dialysis between 2008 and 2019: A French retrospective study. Clin Transplant 2024; 38:e15160. [PMID: 37823237 DOI: 10.1111/ctr.15160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 08/25/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The optimal management of immunosuppressive therapy (IT) after kidney allograft failure (KAF) remains controversial. Although maintaining IT may reduce HLA-sensitization and improve access to retransplantation, it may also increase the rate of immunosuppression-related complications. The overall impact on patient mortality is unknown. The main objective of this study was to compare the evolution of HLA-sensitization 6 months after KAF according to IT management. METHODS Individual clinical and health care data were extracted from the French national end-stage kidney disease registry (Renal Epidemiology and Information Network [REIN]) and the French National Health Data system (SNDS), respectively. Patients aged > 18 years returning to dialysis after KAF between January 2008 and December 2019 in Lorraine were included. Patients were classified into two groups, IT continuation or IT discontinuation. HLA-sensitization was defined as an increase in incompatible graft rate (IGR) between KAF and 6 months post-KAF (change to a higher predefined category (0%-5%), (5%-20%), (20%-50%), (50%-85%), (85%-95%), (95%-98%), (98%-100%)). Secondary outcome was patient survival according to IT management. RESULTS A total of 121 patients were included, 35 (29%) of whom continued IT. HLA-sensitization after KAF tended to be higher in the "IT discontinuation" group (57% vs. 38% in the "IT continuation" group, p = .07). In multivariate analysis, IT continuation was associated with a lower increase in IGR (OR .37, 95% CI [.14; .93]). IT management was not associated with patient mortality. CONCLUSIONS Continuation of IT after KAF was associated with less change in IGR and was not associated with excess mortality.
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Affiliation(s)
- Kevin Ferrari
- Nephrology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Alice Aarnink
- Histocompatibility Laboratory, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
- IMoPA6, UMR7365 CNRS, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - Carole Ayav
- Clinical Epidemiology, Inserm CIC-EC, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Luc Frimat
- Nephrology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | | | | | | | - Sophie Girerd
- Nephrology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
- Université de Lorraine, Inserm, Centre d'Investigation Clinique-1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
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6
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Au EHK, Chapman JR, Teixeira-Pinto A, Craig JC, Wong G. Variations in Risk of Cancer and Death From Cancer According to Kidney Allograft Function, Graft Loss, and Return to Dialysis. Transplantation 2023; 107:1359-1364. [PMID: 36683232 DOI: 10.1097/tp.0000000000004493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cancer incidence and mortality may change with varying kidney allograft function and after graft loss. We aimed to quantify cancer incidence and mortality during periods with a functioning graft and after graft loss. METHODS We included all adult Australians aged 20 and above who commenced kidney replacement therapy between 1982 and 2014 using data from Australia and New Zealand Dialysis and Transplant Registry. We calculated the standardized incidence ratios and standardized mortality ratios (standardized against the Australian general population) for dialysis patients and transplant recipients during periods with a functioning graft and after graft loss. RESULTS A total of 44 765 dialysis patients without transplants, 13 443 with first kidney transplants, 2951 after first graft loss, 1010 with second transplants, and 279 after second graft loss were followed for 274 660 patient-years. Cancer incidence and mortality (per 100 000 patient-years) were 1564 and 760 in dialysis patients, 1564 and 689 in recipients of first transplants, 1188 and 390 after first graft loss, 1525 and 693 after second transplants, and 1645 and 779 after second graft loss. Cancer standardized incidence ratios and standardized mortality ratios (95% confidence intervals) were 1.15 (1.11-1.20) and 1.29 (1.21-1.36) for dialysis patients, 2.03 (1.94-2.13) and 2.50 (2.33-2.69) for recipients following their first transplant, 1.55 (1.29-1.85) and 1.40 (1.00-1.90) after first graft loss, 2.18 (1.79-2.63) and 3.00 (2.23-3.96) for second transplants, 2.59 (1.56-4.04) and 3.82 (1.75-7.25) after second graft loss. CONCLUSIONS In kidney transplant recipients, cancer incidence and mortality are highest during periods with a functioning graft and remained higher than in the general population even after graft loss.
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Affiliation(s)
- Eric H K Au
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Jeremy R Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - Armando Teixeira-Pinto
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
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7
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Correia J, Teixeira B, Mendes G, Fraga A, Silva-Ramos M. Renal cell carcinoma in native kidneys before transplantation - When will we stop waiting? Arch Ital Urol Androl 2023; 95:11240. [PMID: 36924364 DOI: 10.4081/aiua.2023.11240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/17/2023] [Indexed: 03/17/2023] Open
Abstract
INTRODUCTION Kidney transplantation requires immunosuppression, traditionally regarded as a risk factor for progression in all malignancies. Based on the Cincinnati Registry, a waiting period before transplantation is therefore mandatory. However, recent evidence suggests this increased risk is restricted to particular tumors, whereas others like renal cell carcinoma (RCC) are not negatively affected. We aimed to compare oncological outcomes of RCC in native kidneys of end-stage renal disease (ESRD) patients, according to their transplantation or dialysis status. MATERIAL AND METHODS Retrospective analysis of all ESRD patients diagnosed with RCC between 2010 and 2020 in our center. Recurrence-free survival (RFS) and overall survival (OS) were estimated with Kaplan-Meier curves. Multivariable Cox regression model was used to evaluate their association with kidney transplantation. RESULTS Clinical and pathological characteristics were similar between groups. Kidney transplant recipients had similar risk of recurrence (hazard ratio [HR] 0.40, 95% confidence interval [CI) 0.04-4.46, p = 0.458) and overall survival (HR 0.34, 95%CI 0.07-1.77, p = 0.202) as dialyzed patients. On multivariable Cox regression model, presence or absence of transplantation was not significantly associated with RFS (p = 0.479) or OS (p = 0.236). Time on dialysis was the only independent predictor of worse survival (HR 1.86, 95%CI 1.18-2.93, p = 0.008). CONCLUSIONS Most RCC in native kidneys of ESRD patients are low-grade, low-stage and exhibit favourable pathological and outcome features. Immunosuppression does not seem to have an impact on oncological outcomes, but an increased time on dialysis seems to be associated with worse overall survival. Therefore, waiting time for transplantation for these tumors could be reduced.
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Affiliation(s)
- Jorge Correia
- Department of Urology, Centro Hospitalar Universitário do Porto.
| | | | - Gonçalo Mendes
- Department of Urology, Centro Hospitalar Universitário do Porto.
| | - Avelino Fraga
- Department of Urology, Centro Hospitalar Universitário do Porto.
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Seito T, Ishikawa A, Tsuru I, Hikatsu M, Ishibsahi Y, Bae Y, Homma Y. Bladder Preservation After Bilateral Kidney Loss and Bladder Cancer After Renal Transplantation: A Case Report. Transplant Proc 2023; 55:660-663. [PMID: 36997379 DOI: 10.1016/j.transproceed.2023.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/17/2023] [Indexed: 03/30/2023]
Abstract
Kidney transplantation is now a well-established renal replacement therapy. However, renal transplant recipients are reported to have an increased incidence of cancer. Although the recommended waiting period after each cancerous event in a recipient is indicated in the literature, there is no absolute certainty that cancer will develop even after the recommended waiting period. In this study, we experienced a case of bladder cancer after the recommended waiting period in a patient who had bladder preservation after a right nephrectomy and left nephroureterectomy. A 61-year-old man lost his right kidney due to renal cancer in 2007 and his left kidney to urothelial carcinoma in November 2017. The patient wanted a kidney transplant and bladder preservation at the time of the left nephroureterectomy. The patient's wife offered to donate a kidney. After 2 years of hemodialysis, there was no recurrence or metastasis, and with the approval of the Ethics Committee, the patient received a kidney transplant in January 2020. Although the patient's renal function was good after the transplant, a bladder tumor was found 20 months later and was resected transurethrally. The pathology was nonmuscle invasive bladder cancer. This patient, who had lost both kidneys, was treated with bladder preservation therapy. After subsequent kidney transplantation, he developed bladder cancer. Explaining to the patient the possibility of recurrence after a certain period and the increased risk of cancer, in-depth consultation with the patient is necessary regarding bladder preservation. Regular checkups should be continued after transplantation.
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Rosales BM, De La Mata N, Vajdic CM, Kelly PJ, Wyburn K, Webster AC. Cancer Mortality in People Receiving Dialysis for Kidney Failure: An Australian and New Zealand Cohort Study, 1980-2013. Am J Kidney Dis 2022; 80:449-461. [PMID: 35500725 DOI: 10.1053/j.ajkd.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/11/2022] [Indexed: 02/07/2023]
Abstract
RATIONALE & OBJECTIVE Cancer is a significant cause of morbidity in the population with kidney failure; however, cancer mortality in people undergoing dialysis has not been well described. We sought to compare cancer mortality in people on dialysis for kidney failure with cancer mortality in the general population. STUDY DESIGN A retrospective cohort study using linked health-administrative and dialysis registry data. SETTING & PARTICIPANTS All people receiving dialysis represented in the Australian and New Zealand Dialysis and Transplantation Registry, 1980-2013. EXPOSURE Dialysis; hemodialysis (HD) and peritoneal dialysis (PD). OUTCOME Death and underlying cause of death ascertained using health administrative data and classified using International Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) codes. ANALYTICAL APPROACH Indirect standardization on age at death, sex, year, and country to estimate standardized mortality ratios (SMR). RESULTS Over 269,598 person years of observation, 34,100 deaths occurred among 59,648 people on dialysis, including 3,677 cancer deaths. The relative risk of all-site cancer death in dialysis was twice (SMR, 2.4 [95% CI, 2.33-2.49]) that of the general population and highest for oral and pharynx cancers (SMR, 24.3 [95% CI, 18.0-31.5]) and multiple myeloma (SMR, 22.5 [95% CI, 20.3-23.9]). Women on dialysis had a significantly higher risk of all-site cancer mortality (SMR, 2.7 [95% CI, 2.59-2.89]) compared with men (SMR, 2.3 [95% CI, 2.17-2.36]) (P < 0.001). People on HD (SMR, 2.2 [95% CI, 2.11-2.30]) experienced greater excess deaths from all-site cancer compared with people on PD (SMR, 1.3 [95% CI, 1.23-1.44]). Excess deaths have gradually decreased over time for all-site, multiple myeloma, and kidney cancers (P < 0.001) but have not kept up with improvements in the general population. By contrast, among people receiving dialysis, excess deaths increased for colorectal and lung cancers (P < 0.001). LIMITATIONS Confirmation of cancer diagnoses and population incidence data were not available; inability to exclude pre-existing cancers. CONCLUSIONS People on dialysis experience excess all-site and site-specific cancer mortality compared with the general population. Mortality differs by modality type, age, and sex. Understanding the role of kidney failure and other morbidities in the treatment of cancer is important for shared decision-making regarding cancer treatments and identifying potential approaches to improve outcomes.
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Affiliation(s)
| | | | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | | | - Kate Wyburn
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
| | - Angela C Webster
- Sydney School of Public Health, Sydney, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
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10
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Girerd S, Duarte K, Couchoud C, Laurain E, Courivaud C, Bauwens M, Kessler M, Frimat L, Girerd N. Association between kidney retransplantation and survival according to age in the French national cohort of dialysis patients. Am J Transplant 2022; 22:2028-2040. [PMID: 35510748 PMCID: PMC9542860 DOI: 10.1111/ajt.17081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/05/2022] [Accepted: 04/28/2022] [Indexed: 01/25/2023]
Abstract
The mean age of patients returning to dialysis after a first kidney transplantation (KT) has increased in the past decades. We aimed to assess the association between second KT (2KT) and survival according to age at the time of return to dialysis. Data of 5334 patients registered in the French Renal Epidemiology and Information Network (REIN) (mean age 56.6 ± 13.6 years) who returned to dialysis after a first KT were collected. The association of 2KT with death was assessed using a propensity score-based analysis taking into account baseline and follow-up variables. In relisted patients (3272 patients, 61.3%), retransplantation was associated with better overall survival in comparison with patients who remained in dialysis (adjusted HR 0.75 [0.63-0.89], p = .0009). The survival advantage conferred by retransplantation gradually declined with increasing age (adjusted HR 0.41 [0.24-0.70] in patients <50, HR 0.94 (0.69-1.27) in patients aged 70 or older, p for interaction 0.034 for age considered as a continuous variable). 2KT is associated with better survival as opposed to remaining on dialysis after a first kidney graft failure. Nevertheless, this survival benefit is age dependent and diminishes with increasing age. The risk/benefit ratio should be comprehensively assessed in the oldest patients when relisting is considered.
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Affiliation(s)
- Sophie Girerd
- Université de LorraineInsermCentre d’Investigations Cliniques‐ 1433, and Inserm U1116CHRU NancyF‐CRIN INI‐CRCTNancyFrance,Nephrology DepartmentUniversity Hospital of NancyVandoeuvre les NancyFrance
| | - Kevin Duarte
- Université de LorraineInsermCentre d’Investigations Cliniques‐ 1433, and Inserm U1116CHRU NancyF‐CRIN INI‐CRCTNancyFrance
| | | | - Emmanuelle Laurain
- Nephrology DepartmentUniversity Hospital of NancyVandoeuvre les NancyFrance
| | - Cécile Courivaud
- Department of Nephrology, Dialysis, and Renal TransplantationUniversity Hospital of BesançonBesançonFrance
| | - Marc Bauwens
- Department of Nephrology, Dialysis, and Renal TransplantationUniversity Hospital of PoitiersPoitiersFrance
| | - Michèle Kessler
- Nephrology DepartmentUniversity Hospital of NancyVandoeuvre les NancyFrance
| | - Luc Frimat
- Nephrology DepartmentUniversity Hospital of NancyVandoeuvre les NancyFrance
| | - Nicolas Girerd
- Université de LorraineInsermCentre d’Investigations Cliniques‐ 1433, and Inserm U1116CHRU NancyF‐CRIN INI‐CRCTNancyFrance
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11
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Lim LM, Chung WY, Hwang DY, Yu CC, Ke HL, Liang PI, Lin TW, Cheng SM, Huang AM, Kuo HT. Whole-exome sequencing identified mutational profiles of urothelial carcinoma post kidney transplantation. J Transl Med 2022; 20:324. [PMID: 35864526 PMCID: PMC9301867 DOI: 10.1186/s12967-022-03522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
Kidney transplantation is a lifesaving option for patients with end-stage kidney disease. In Taiwan, urothelial carcinoma (UC) is the most common de novo cancer after kidney transplantation (KT). UC has a greater degree of molecular heterogeneity than do other solid tumors. Few studies have explored genomic alterations in UC after KT. We performed whole-exome sequencing to compare the genetic alterations in UC developed after kidney transplantation (UCKT) and in UC in patients on hemodialysis (UCHD). After mapping and variant calling, 18,733 and 11,093 variants were identified in patients with UCKT and UCHD, respectively. We excluded known single-nucleotide polymorphisms (SNPs) and retained genes that were annotated in the Catalogue of Somatic Mutations in Cancer (COSMIC), in the Integrative Onco Genomic cancer mutations browser (IntOGen), and in the Cancer Genome Atlas (TCGA) database of genes associated with bladder cancer. A total of 14 UCKT-specific genes with SNPs identified in more than two patients were included in further analyses. The single-base substitution (SBS) profile and signatures showed a relative high T > A pattern compared to COMSIC UC mutations. Ingenuity pathway analysis was used to explore the connections among these genes. GNAQ, IKZF1, and NTRK3 were identified as potentially involved in the signaling network of UCKT. The genetic analysis of posttransplant malignancies may elucidate a fundamental aspect of the molecular pathogenesis of UCKT.
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Affiliation(s)
- Lee-Moay Lim
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Yu Chung
- Department of Computer Science and Information Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Daw-Yang Hwang
- National Institute of Cancer Research, National Health Research Institute, Tainan, Taiwan
| | - Chih-Chuan Yu
- National Institute of Cancer Research, National Health Research Institute, Tainan, Taiwan
| | - Hung-Lung Ke
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peir-In Liang
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ting-Wei Lin
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Siao Muk Cheng
- National Institute of Cancer Research, National Health Research Institute, Tainan, Taiwan
| | - A-Mei Huang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Ph.D. Program in Toxicology, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Biochemistry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Hung-Tien Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. .,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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12
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Pinto-Filho VA, Nascimento E, Cunha APL, Assis BPS, Lasmar MF, Vianna HR, Fabreti-Oliveira RA. Malignancy Diseases in Kidney Transplantation, Clinical Outcomes, Patient, and Allograft Survival: A Case-Control Study. Transplant Proc 2022; 54:1253-1261. [PMID: 35750515 DOI: 10.1016/j.transproceed.2022.02.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/09/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Malignancy is a well-known complication in patients after kidney transplantation (KT), but its effect on posttransplant outcomes, allograft, and patient survival remains unexplored. The aim of this study is to report the impact of the comorbidity on clinical outcome, function, and failure of an allograft kidney. METHODS This case-control study included 101 KT patients. Twenty-six patients who developed cancer (CA) were assigned to the case group and 75 to the control group. Statistical analysis was performed using logistic regression models, and graft survival was analyzed using the Kaplan-Meier curve. RESULTS Non-melanoma skin CA was the most common malignancy, accounting for almost 60% of cases, followed by stomach CA, prostate CA, and lymphoproliferative diseases (7.70% each). Difference in graft and patient survival was not significant between the two groups (P > .05). A tumor in nonfunctioning in the first nonfunctioning KT was identified in 1 KT patient with a second allograft and by anatomopathological was detect Fuhrman grade II renal cell carcinoma. This KT patient was in good clinical condition with serum creatinine level of 1.5 mg/dL. CONCLUSIONS No association was observed between CA development and risk factors, including family history and smoking habit, and no differences in allograft and patient survival were found. Nevertheless, in our data, CA in KT patients occurred early after transplantation. Renal cell carcinoma in allograft failure was identified in a patient; that suggested that nephrectomy of kidney failure must be performed to avoid patient allosensitization and neoplasia. Thus, we suggest continuous screening of malignancy diseases for KT patients.
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Affiliation(s)
| | - Evaldo Nascimento
- IMUNOLAB - Laboratory of Histocompatibility, Belo Horizonte, Minas Gerais, Brazil; Institute of Research and Education of the Hospital Santa Casa, Belo Horizonte, Minas Gerais, Brazil
| | - Antônio P L Cunha
- Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil
| | - Bernardo P S Assis
- Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil
| | - Marcus F Lasmar
- Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil
| | - Heloísa R Vianna
- Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil
| | - Raquel A Fabreti-Oliveira
- Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; IMUNOLAB - Laboratory of Histocompatibility, Belo Horizonte, Minas Gerais, Brazil.
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13
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Bermejo S, Bolufer M, Riveiro-Barciela M, Soler MJ. Immunotherapy and the Spectrum of Kidney Disease: Should We Individualize the Treatment? Front Med (Lausanne) 2022; 9:906565. [PMID: 35775000 PMCID: PMC9237407 DOI: 10.3389/fmed.2022.906565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/10/2022] [Indexed: 01/11/2023] Open
Abstract
The new targeted cancer therapies including immune checkpoint inhibitors (ICIs) have been demonstrated to improve the survival of oncological patients, even in cases of metastatic cancer. In the past 5 years, several studies have revealed that ICI can produce several immune-mediated toxicities involving different organs, such as the skin, the gastrointestinal tract, the liver, and, of course, the kidney. The most frequent lesion of immunotoxicity in the kidney is acute interstitial nephritis (AIN), although other nephropathies have also been described as a consequence of the use of ICI, such as glomerulonephritis and acute thrombotic microangiopathy, among others. In addition, kidney rejection has also been reported in kidney transplant patients treated with ICI. Normally randomized clinical trials with ICI exclude patients with end-stage kidney disease, namely, patients undergoing dialysis and kidney transplant patients. Several important questions need to be addressed in relation to immunotherapy and patients with kidney disease: (a) when to start corticosteroid therapy in a patient with suspected acute kidney injury (AKI) related to ICI, (b) the moment of nephrologist referral and kidney biopsy indication, (c) management of ICI in patients undergoing dialysis, and (d) the effect of ICI in kidney transplantation, immunosuppressive personalized treatment, and risk of allograft rejection in kidney transplant patients. The objective of this review was to summarize the recently published literature on a wide spectrum of kidney disease patients with cancer and ICI. This review will address three main important groups of individuals with kidney disease and cancer immunotherapy, AKI associated with ICI, patients undergoing dialysis, and kidney transplant recipients. We believe that the information provided in this review will enlighten the personalized ICI treatment in individuals with a broader spectrum of kidney diseases.
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Affiliation(s)
- Sheila Bermejo
- Nephrology Department, Vall d'Hebron Hospital, Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain
- *Correspondence: Sheila Bermejo
| | - Mónica Bolufer
- Nephrology Department, Vall d'Hebron Hospital, Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain
| | - Mar Riveiro-Barciela
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Maria José Soler
- Nephrology Department, Vall d'Hebron Hospital, Barcelona, Spain
- Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Barcelona, Spain
- Maria José Soler
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14
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Lim WH, Ooi E, Pankaj A, Teixeira-Pinto A, Lin Y, Johnson DW, Hawley CM, Viecelli AK, Pilmore H, Roberts MA, Davies CE, Krishnan A, Wong G. The incidence of cancer recurrence and new cancer following commencement of dialysis in patients with prior cancers. Clin Kidney J 2022; 15:1770-1781. [PMID: 36003660 PMCID: PMC9394713 DOI: 10.1093/ckj/sfac124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background Patients with kidney failure have a higher cancer risk compared with the age-matched general population. However, the outcomes of incident dialysis patients with a prior cancer history are unknown. Methods Using Australia and New Zealand Dialysis and Transplant Registry data (2000–2019), the outcomes and survival probabilities of incident dialysis patients with prior cancers and having experienced a cancer recurrence or having developed a new cancer after dialysis commencement were described. Results Of 4912 patients with prior cancers before dialysis commencement, 323 (7%) and 343 (7%) patients experienced cancer recurrence or developed new cancers after dialysis initiation, respectively. The median time from dialysis commencement to cancer recurrence was 1.2 years [interquartile range (IQR) 0.5–2.8] and was 2.0 years (IQR 0.7–4.0) for new cancer occurrence. Of those with cancer recurrence, 80% presented with metastatic disease and one in two patients died from cancer, with a median time from cancer recurrence to death of 0.5 years (IQR 0.2–1.7). Of those who developed new cancer, urinary tract and respiratory cancers were the most frequent cancer types, with a median time from new cancer diagnosis to death of 1.3 years (IQR 0.4–3.1). The 3-year survival probabilities on dialysis following cancer recurrence and new cancer were 19% [95% confidence interval (CI) 15–24] and 41% (35–47), respectively. Conclusion Among incident dialysis patients with a prior cancer history, 14% experienced cancer recurrence or developed a new cancer. Patients who experienced cancer recurrence or developed new cancer have poor outcomes, with ˂50% surviving beyond 3 years. These findings suggest the need to have a greater understanding of the characteristics, cancer screening, treatment responses and reasons for commencing dialysis in patients with kidney failure and prior cancer history, which may help in the shared clinical decision-making process when considering dialysis for these patients.
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Affiliation(s)
- Wai H Lim
- Medical School, University of Western Australia , Perth , Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital , Perth , Australia
| | - Esther Ooi
- Medical School, University of Western Australia , Perth , Australia
- School of Biomedical Sciences, University of Western Australia , Perth , Australia
| | - Aashi Pankaj
- School of Biomedical Sciences, University of Western Australia , Perth , Australia
| | - Armando Teixeira-Pinto
- School of Public Health, Faculty of Medicine and Health, Sydney University , Sydney, Australia
| | - Yingxin Lin
- School of Public Health, Faculty of Medicine and Health, Sydney University , Sydney, Australia
- Faculty of Science, School of Mathematics and Science, University of Sydney , Sydney, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital , Queensland , Australia
- Australasian Kidney Trials Network, University of Queensland , Queensland , Australia
- Translational Research Institute , Brisbane , Australia
| | - Carmel M Hawley
- Department of Nephrology, Princess Alexandra Hospital , Queensland , Australia
- Australasian Kidney Trials Network, University of Queensland , Queensland , Australia
- Translational Research Institute , Brisbane , Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital , Queensland , Australia
- Australasian Kidney Trials Network, University of Queensland , Queensland , Australia
| | - Helen Pilmore
- Department of Renal Medicine, Auckland City Hospital , Auckland , New Zealand
- Department of Medicine, Auckland University , Auckland , New Zealand
| | - Matthew A Roberts
- Eastern Health Clinical School, Monash University , Victoria , Australia
| | - Christopher E Davies
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute , Adelaide, Australia
- Adelaide Medical School, University of Adelaide , Adelaide, Australia
| | - Anoushka Krishnan
- Department of Renal Medicine, Royal Perth Hospital , Perth , Australia
| | - Germaine Wong
- School of Public Health, Faculty of Medicine and Health, Sydney University , Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead , Sydney, Australia
- Department of Renal Medicine and National Pancreas Transplant Unit, Westmead Hospital , Sydney, Australia
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15
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Pyrża M, Małyszko J, Głogowski T, Wieliczko M, Żebrowski P, Małyszko J. Kidney Transplant Recipients Have Higher Malignancy Prevalence Than Hemodialyzed Patients. Transplant Proc 2022; 54:972-975. [DOI: 10.1016/j.transproceed.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/07/2022] [Indexed: 10/18/2022]
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16
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Taborelli M, Serraino D, Cimaglia C, Furian L, Biancone L, Busnach G, Todeschini P, Bossini N, Iaria M, Campise MR, Veroux M, Citterio F, Ambrosini A, Cantaluppi V, Mangino M, Pisani F, Tisone G, Fiorentino M, Argiolas D, Caputo F, Piselli P. The impact of cancer on the risk of death with a functioning graft of Italian kidney transplant recipients. Am J Transplant 2022; 22:588-598. [PMID: 34464503 DOI: 10.1111/ajt.16825] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/04/2021] [Accepted: 08/26/2021] [Indexed: 01/25/2023]
Abstract
This study assessed the impact of cancer on the risk of death with a functioning graft of kidney transplant (KT) recipients, as compared to corresponding recipients without cancer. A matched cohort study was conducted using data from a cohort of 13 245 individuals who had undergone KT in 17 Italian centers (1997-2017). Cases were defined as subjects diagnosed with any cancer after KT. For each case, two controls matched by gender, age, and year at KT were randomly selected from cohort members who were cancer-free at the time of diagnosis of the index case. Overall, 292 (20.5%) deaths with a functioning graft were recorded among 1425 cases and 238 (8.4%) among 2850 controls. KT recipients with cancer had a greater risk of death with a functioning graft (hazard ratio, HR = 3.31) than their respective controls. This pattern was consistent over a broad range of cancer types, including non-Hodgkin lymphoma (HR = 33.09), lung (HR = 20.51), breast (HR = 8.80), colon-rectum (HR = 3.51), and kidney (HR = 2.38). The survival gap was observed throughout the entire follow-up period, though the effect was more marked within 1 year from cancer diagnosis. These results call for close posttransplant surveillance to detect cancers at earlier stages when treatments are more effective in improving survival.
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Affiliation(s)
- Martina Taborelli
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Diego Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Claudia Cimaglia
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Rome, Italy
| | - Lucrezia Furian
- Unit of Kidney and Pancreas Transplantation, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Luigi Biancone
- Division of Nephrology Dialysis and Transplantation, Renal Transplantation Center "A. Vercellone", Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Ghil Busnach
- Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Paola Todeschini
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, IRCCS S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Nicola Bossini
- Unit of Nephrology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Maurizio Iaria
- Department of General and Specialized Surgery, Division of General Surgery, Transplant Surgery Unit, Parma University Hospital, Parma, Italy
| | - Maria R Campise
- Unit of Nephrology, Dialysis, and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Massimiliano Veroux
- Organ Transplantation Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Franco Citterio
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Ambrosini
- Renal Transplant Unit, Azienda Ospedaliera Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Vincenzo Cantaluppi
- Nephrology and Kidney Transplantation Unit, Department of Translational Medicine, University of Piemonte Orientale (UPO), "Maggiore della Carità" University Hospital, Novara, Italy
| | - Margherita Mangino
- Nephrology, Dialysis, Transplantation Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Francesco Pisani
- General and Transplant Surgery Department, University of L'Aquila, L'Aquila, Italy
| | - Giuseppe Tisone
- UOC Transplant Unit, Department of Surgery, Tor Vergata University, Rome, Italy
| | - Marco Fiorentino
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Davide Argiolas
- Renal Transplant Unit, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Flavia Caputo
- Nephrology Dialysis and Renal Transplant Department, Civico and Di Cristina Hospital, Palermo, Italy
| | - Pierluca Piselli
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani" IRCCS, Rome, Italy
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17
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Miyamoto Y, Iwagami M, Aso S, Uda K, Fushimi K, Hamasaki Y, Nangaku M, Yasunaga H, Doi K. Postoperative outcomes of cancer surgery in patients with and without kidney failure with dialysis therapy: A matched-pair cohort study. Clin Kidney J 2022; 15:1137-1143. [PMID: 35664265 PMCID: PMC9155240 DOI: 10.1093/ckj/sfac005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background The difference in outcomes of cancer surgery between patients with and without kidney failure with dialysis therapy (KFDT) remains uncertain. Methods Using 2010–18 data in a national inpatient database in Japan, we identified patients who had undergone resection of colorectal, lung, gastric or breast cancer. We matched selected patient characteristics, type of cancer, surgical procedure and hospital of up to four patients without KFDT to each patient with KFDT. We assessed 30-day mortality and postoperative complications. Results Through matching, we identified 2248 patients with KFDT (807 with colorectal, 579 with lung, 500 with gastric and 362 with breast cancer) and 8210 patients without KFDT (2851 with colorectal, 2216 with lung, 1756 with gastric and 1387 with breast cancer). Postoperative complications occurred in a higher proportion of patients with KFDT than of those without KFDT after colorectal {20.3% versus 14.6%; risk difference (RD): 5.7% [95% confidence interval (95% CI) 2.6%–8.8%]}, lung [18.0% versus 12.9%; RD: 5.1% (95% CI 1.6%–8.4%)], gastric [25.0% versus 13.2%; RD: 11.8% (95% CI 7.6%–16.2%)] and breast cancer surgery [7.5% versus 3.5%; RD: 3.9% (95% CI 1.1%–6.9%)]. Patients with KFDT had a higher 30-day mortality than those without KFDT after gastric cancer surgery [1.6% versus 0.3%; RD: 1.3% (95% CI 0.1%–2.3%)]. Heart failure and ischemic heart disease occurred more frequently in patients with KFDT. Conclusions Patients with KFDT had higher rates of postoperative complications and 30-day mortality; however, RDs varied between cancer types. The higher rates of postoperative complications in patients with KFDT were mainly attributable to cardiovascular complications.
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Affiliation(s)
- Yoshihisa Miyamoto
- Division of Nephrology and Endocrinology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
- Institute for Cancer Control, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Shotaro Aso
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kazuaki Uda
- Department of Health Services Research, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Yoshifumi Hamasaki
- Division of Nephrology and Endocrinology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
- Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kent Doi
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
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18
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Dahle DO, Skauby M, Langberg CW, Brabrand K, Wessel N, Midtvedt K. Renal Cell Carcinoma and Kidney Transplantation: A Narrative Review. Transplantation 2022; 106:e52-e63. [PMID: 33741842 PMCID: PMC8667800 DOI: 10.1097/tp.0000000000003762] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/08/2021] [Accepted: 03/03/2021] [Indexed: 11/27/2022]
Abstract
Kidney transplant recipients (KTRs) are at increased risk of developing renal cell carcinoma (RCC). The cancer can be encountered at different steps in the transplant process. RCC found during work-up of a transplant candidate needs treatment and to limit the risk of recurrence usually a mandatory observation period before transplantation is recommended. An observation period may be omitted for candidates with incidentally discovered and excised small RCCs (<3 cm). Likewise, RCC in the donor organ may not always preclude usage if tumor is small (<2 to 4 cm) and removed with clear margins before transplantation. After transplantation, 90% of RCCs are detected in the native kidneys, particularly if acquired cystic kidney disease has developed during prolonged dialysis. Screening for RCC after transplantation has not been found cost-effective. Treatment of RCC in KTRs poses challenges with adjustments of immunosuppression and oncologic treatments. For localized RCC, excision or nephrectomy is often curative. For metastatic RCC, recent landmark trials in the nontransplanted population demonstrate that immunotherapy combinations improve survival. Dedicated trials in KTRs are lacking. Case series on immune checkpoint inhibitors in solid organ recipients with a range of cancer types indicate partial or complete tumor response in approximately one-third of the patients at the cost of rejection developing in ~40%.
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Affiliation(s)
- Dag Olav Dahle
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Morten Skauby
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Knut Brabrand
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Nicolai Wessel
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
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19
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Abstract
Cancer remains a significant cause of morbidity and mortality in kidney transplant recipients, due to long-term immunosuppression. Salient issues to consider in decreasing the burden of malignancy among kidney transplant recipients include pretransplant recipient evaluation, post-transplant screening and monitoring, and optimal treatment strategies for the kidney transplant recipients with cancer. In this review, we address cancer incidence and outcomes, approaches to cancer screening and monitoring pretransplant and post-transplant, as well as treatment strategies, immunosuppressive management, and multidisciplinary approaches in the kidney transplant recipients with cancer.
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20
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The Effect of Statins in Cancer Risk Reduction in Patients on Dialysis: A Population-Based Case-Control Study. J Clin Med 2021; 10:jcm10235602. [PMID: 34884304 PMCID: PMC8658442 DOI: 10.3390/jcm10235602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary The lifetime risk of several cancers is elevated in patients receiving dialysis following kidney failure compared with the general population. Using a large dataset available in Taiwan, we conducted a nationwide population-based cohort study to delineate the relationship between statin use and cancer risk in patients on dialysis. Our study provides an association that statins reduce the risk of malignancy in patients on dialysis, especially with a longer treatment duration, and irrespective of the type of statin prescription. The use of statins in patients on dialysis was associated with significantly lower incidences in developing respiratory, soft tissue and connective tissue, breast, gynecological, prostate, central nervous system, and lymphatic and hematopoietic cancer. Abstract Background: To realize whether statins reduce the risk of cancer in susceptible dialysis populations, this study analyzed the relationship between statin use and cancer risk in patients on dialysis. Methods: Patients having a history of chronic kidney disease with hemodialysis or peritoneal dialysis and receiving statin prescriptions or not were enrolled. The main outcome was cancer diagnosis. This study used univariate and multivariate Cox regression analyses. Results: In total, 4236 individuals in the statin group and 8472 individuals in the statin nonuser group were included in the study. Multivariate Cox regression analysis revealed that statin users are significantly less likely to develop cancer than statin nonusers (adjusted hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.78–0.90). Subgroup analyses revealed that statin cumulative defined daily doses >365 were associated with a significantly decreased risk of cancer incidence (adjusted HR 0.59, 95% CI 0.45–0.87), and statin users have a reduced risk of respiratory, soft tissue and connective tissue, breast, gynecological, prostate, central nervous system, and lymphatic and hematopoietic cancer than nonusers. Conclusions: Our population-based cohort study provides an association that statins reduce the risk of malignancy in patients on dialysis, especially with a longer treatment duration, and certain types of cancer.
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Rossi E, Schinzari G, Maiorano BA, Esposito I, Acampora A, Romagnoli J, Stefani AD, Regno LD, Lancellotta V, Fionda B, Tagliaferri L, Peris K, Tortora G. Immune-checkpoint inhibitors in renal transplanted patients affected by melanoma: a systematic review. Immunotherapy 2021; 14:65-75. [PMID: 34751039 DOI: 10.2217/imt-2021-0195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Kidney transplantation leads to an increased risk of cancer. Melanoma is one of the most frequent neoplasms in kidney transplant recipients. Transplanted patients were excluded from trials with checkpoint inhibitors in melanoma. The authors performed a systematic review regarding the use of anti-PD1 and anti-CTLA4 agents in renal transplanted patients with melanoma. Thirty-four cases were included (24 progressive disease, eight partial responses and one stable disease) but no complete response were reported. Fourteen graft rejections were observed, especially with anti-PD1 agent. The median time from the start of immune-checkpoint inhibitor and rejection was 21 days. Response rate was similar between patients with rejection and patients without rejection. The benefit of immune-checkpoint inhibitors versus the risk of allograft rejection should be carefully weighted for each patient. A multidisciplinary approach should be considered to discuss the most appropriate treatment for every case, given the aggressiveness of melanoma in these subsets of patients.
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Affiliation(s)
- Ernesto Rossi
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, 00168, Italia
| | - Giovanni Schinzari
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, 00168, Italia.,Oncologia Medica, Università Cattolica del Sacro Cuore, Roma, 00168, Italia
| | - Brigida Anna Maiorano
- Unità di Oncologia, Fondazione Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo (FG), 71013, Italia
| | - Ilaria Esposito
- Dermatologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, 00168, Italia
| | - Anna Acampora
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Jacopo Romagnoli
- Trapianti di Rene, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, 00168, Italia.,Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, 00168, Italia
| | - Alessandro Di Stefani
- Dermatologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, 00168, Italia
| | - Laura Del Regno
- Dermatologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, 00168, Italia
| | - Valentina Lancellotta
- Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, 00168, Italia
| | - Bruno Fionda
- Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, 00168, Italia
| | - Luca Tagliaferri
- Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, 00168, Italia
| | - Ketty Peris
- Dermatologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, 00168, Italia.,Dermatologia, Università Cattolica del Sacro Cuore, Roma, 00168, Italia
| | - Giampaolo Tortora
- Oncologia Medica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, 00168, Italia.,Oncologia Medica, Università Cattolica del Sacro Cuore, Roma, 00168, Italia
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22
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Shirazian S, Starakiewicz P, Latcha S. Cancer Screening in End-Stage Kidney Disease. Adv Chronic Kidney Dis 2021; 28:502-508.e1. [PMID: 35190116 DOI: 10.1053/j.ackd.2021.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/14/2021] [Indexed: 11/11/2022]
Abstract
The incidence of cancer is higher in patients with end-stage kidney disease (ESKD) than among the general population. Despite this, screening for cancer is generally not cost-effective and may worsen quality of life in these patients. This is due to high mortality rates (patients are not living long enough to reap the benefits of screening), the inaccuracy of cancer screening tests, and the increased risks associated with therapy in patients with ESKD. Specific groups of patients with ESKD who have a longer-than-expected life expectancy or higher-than-expected cancer risk may benefit from screening. These groups include patients on peritoneal dialysis, patients on home hemodialysis, Black and Asian-American patients, transplant-eligible patients, and those at higher risk of cancer including patients with acquired cystic kidney disease, those who have been previously exposed to cytotoxic agents or aristolochic acid, and patients with a genetic predisposition to cancer. In this narrative review, we will examine the prevalence of and risk factors for cancer in patients with ESKD and the effectiveness of cancer screening, and discuss specific situations in which cancer screening may be effective.
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23
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Kitchlu A, Jhaveri KD, Sprangers B, Yanagita M, Wanchoo R. Immune checkpoint inhibitor use in patients with end-stage kidney disease: an analysis of reported cases and literature review. Clin Kidney J 2021; 14:2012-2022. [PMID: 34476087 PMCID: PMC8406068 DOI: 10.1093/ckj/sfab090] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Indexed: 01/13/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs), immunomodulatory antibodies that are used to enhance the immune system, have substantially improved the prognosis of patients with advanced malignancy. As the use of ICI therapy becomes increasingly widespread across different types of cancer, their use in patients receiving dialysis is likely to increase. In this review we summarize the current literature on the use of ICIs in end-stage kidney disease (ESKD) patients and provide aggregate data from reported cases and series. Based on available pharmacological information, ICIs require no dosing adjustment in ESKD patients. Analysis of the reported cases in the literature demonstrates a similar incidence of immune-related adverse events in patients with ESKD receiving dialysis as compared with the general population (49%). Severe reactions graded as 3 and 4 have been seen in 15 patients (16%). As such, it is important that these patients are monitored very closely for immune-related adverse events; however, the risk of these adverse events should not preclude patients on dialysis from receiving these therapies. Cancer remission (complete and partial) was seen in close to 30% of patients, stable disease was seen in 28% and progression of disease in ∼36%. One-third of the patients died. Urothelial and renal cell cancer represented approximately half of all treated cancers and accounted for ∼50% of all deaths reported. Additional data in the dialysis population with the use of ICIs and involvement in prospective studies are needed to better assess outcomes, particularly within specific cancer types.
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Affiliation(s)
- Abhijat Kitchlu
- Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine, Northwell Health, Great Neck, NY, USA
| | - Ben Sprangers
- Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Immunology, Rega Institute, KU Leuven, Leuven, Belgium
- Division of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Rimda Wanchoo
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine, Northwell Health, Great Neck, NY, USA
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24
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Saly DL, Eswarappa MS, Street SE, Deshpande P. Renal Cell Cancer and Chronic Kidney Disease. Adv Chronic Kidney Dis 2021; 28:460-468.e1. [PMID: 35190112 DOI: 10.1053/j.ackd.2021.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 11/11/2022]
Abstract
The association between chronic kidney disease (CKD) and renal cell carcinoma (RCC) is bidirectional and multifactorial. Risk factors such as hypertension, diabetes mellitus, obesity, and smoking increase the risk of both CKD and RCC. CKD can lead to RCC via an underlying cystic disease or oxidative stress. RCC can cause CKD because of the tumor itself, surgical reduction of renal mass (either partial or radical nephrectomy), and perioperative acute kidney injury. Medical therapies such as immune checkpoint inhibitors and vascular endothelial growth factor inhibitors can lead to acute kidney injury and resultant CKD. Clinicians need to be aware of the complex, bidirectional interplay between both diseases.
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25
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Kim CS, Kim B, Suh SH, Oh TR, Kim M, Choi HS, Bae EH, Ma SK, Han KD, Kim SW. Risk of Kidney Failure in Patients With Cancer: A South Korean Population-Based Cohort Study. Am J Kidney Dis 2021; 79:507-517.e1. [PMID: 34416352 DOI: 10.1053/j.ajkd.2021.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 06/09/2021] [Indexed: 12/24/2022]
Abstract
RATIONALE & OBJECTIVE Reduced kidney function is associated with an increased risk of cancer; however, it is unclear if cancer increases the risk of kidney failure with replacement therapy (KFRT). We assessed the risk of KFRT among patients with various types of cancer collectively and with specific types of cancer. STUDY DESIGN Retrospective population-based cohort study. SETTING & PARTICIPANTS A total of 2,473,095 participants with (n = 824,365) or without (n = 1,648,730) cancer registered in the Korean National Health Insurance Service database. PREDICTORS Cancer and cancer subtypes defined using International Classification of Diseases, 10th Revision, Clinical Modification, codes. OUTCOMES Primary outcome was KFRT defined as the initiation of hemodialysis or peritoneal dialysis or kidney transplantation. ANALYTICAL APPROACH For each patient with cancer, 2 controls matched for age, sex, estimated glomerular filtration rate, diabetes, and hypertension were included. To address the competing risk of death, a competing risk survival analysis was conducted using the Fine and Gray method. RESULTS Occurrence of KFRT was higher in patients with cancer than in controls without cancer (incidence rates of 1.07 vs 0.51 cases per 1,000 person-years). Competing risk analysis showed that cancer was significantly associated with an increased risk of KFRT after adjusting for other potential predictors (adjusted hazard ratio, 2.29 [95% CI, 2.20-2.39]). Multiple myeloma, leukemia, lymphoma, and kidney, ovarian, and liver cancer were most significantly associated with an increased KFRT risk, with multiple myeloma conferring the highest risk across age and sex groups. All subgroups of patients with cancer (based on age, sex, smoking, alcohol, exercise, obesity, and comorbid conditions) exhibited a higher risk of KFRT. LIMITATIONS Causal association between cancer and kidney outcomes could not be confirmed. CONCLUSIONS Patients with cancer, particularly those with multiple myeloma, exhibited an increased risk of KFRT after accounting for the competing risk of death.
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Affiliation(s)
- Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Sang Heon Suh
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Minah Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Korea.
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26
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Narcotic Use for Acute Postoperative Pain Management in Mohs Micrographic Surgery Patients With End Stage Renal Disease: A Review of the Literature. Dermatol Surg 2021; 47:454-461. [PMID: 33625143 DOI: 10.1097/dss.0000000000002949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uncontrolled acute postoperative pain presents a significant management challenge when opioids are used in patients with end-stage renal disease (ESRD). Currently, there is a lack of quality pharmacokinetic and pharmacodynamic data regarding opioid medication use in ESRD patients to optimize safe and effective management. OBJECTIVE To review the published literature on pharmacologic evidence for and against the use of opioid medications for acute postoperative pain following Mohs micrographic surgery in ESRD patients. METHODS A search of PubMed was conducted to identify articles on the pharmacokinetic and pharmacodynamic properties of opioid pain medications in ESRD patients through March 1, 2020. RESULTS Seventy-five articles were reviewed. Limited data exist on opioids safe for use in ESRD and are mostly confined to small case series. Studies suggest tramadol and hydromorphone could be considered when indicated. Methadone may be a safe option, but should be reserved for treatment coordinated by a trained pain subspecialist. CONCLUSION Randomized clinical trials are lacking. Studies that are available are not sufficient to perform a quantitative methodologic approach. Evidence supports the judicious use of postoperative opioid medications in ESRD patients at the lowest possible dose to achieve clinically meaningful improvement in pain and function.
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27
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Peired AJ, Lazzeri E, Guzzi F, Anders HJ, Romagnani P. From kidney injury to kidney cancer. Kidney Int 2021; 100:55-66. [PMID: 33794229 DOI: 10.1016/j.kint.2021.03.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
Epidemiologic studies document strong associations between acute or chronic kidney injury and kidney tumors. However, whether these associations are linked by causation, and in which direction, is unclear. Accumulating data from basic and clinical research now shed light on this issue and prompt us to propose a new pathophysiological concept with immanent implications in the management of patients with kidney disease and patients with kidney tumors. As a central paradigm, this review proposes the mechanisms of kidney damage and repair that are active during acute kidney injury but also during persistent injuries in chronic kidney disease as triggers of DNA damage, promoting the expansion of (pre-)malignant cell clones. As renal progenitors have been identified by different studies as the cell of origin for several benign and malignant kidney tumors, we discuss how the different types of kidney tumors relate to renal progenitors at specific sites of injury and to germline or somatic mutations in distinct signaling pathways. We explain how known risk factors for kidney cancer rather represent risk factors for kidney injury as an upstream cause of cancer. Finally, we propose a new role for nephrologists in kidney cancer (i.e., the primary and secondary prevention and treatment of kidney injury to reduce incidence, prevalence, and recurrence of kidney cancer).
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Affiliation(s)
- Anna Julie Peired
- Excellence Centre for Research, Transfer and High Education for the Development of DE NOVO Therapies, University of Florence, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Elena Lazzeri
- Excellence Centre for Research, Transfer and High Education for the Development of DE NOVO Therapies, University of Florence, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Francesco Guzzi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Hans-Joachim Anders
- Division of Nephrology, Medizinische Klinik and Poliklinik IV, Ludwig Maximilian University Klinikum, Munich, Germany
| | - Paola Romagnani
- Excellence Centre for Research, Transfer and High Education for the Development of DE NOVO Therapies, University of Florence, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy; Nephrology and Dialysis Unit, Meyer Children's University Hospital, Florence, Italy.
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28
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Hellemans R, Pengel L, Choquet S, Maggiore U. Managing immunosuppressive therapy in potentially cured post-kidney transplant cancer (excluding non-melanoma skin cancer): overview of the available evidence and guidance for shared decision making. Transpl Int 2021; 34:1789-1800. [PMID: 34146426 PMCID: PMC8518116 DOI: 10.1111/tri.13952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/12/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
Kidney transplant recipients (KTRs) have increased incidence of de novo cancers. After having undergone treatment for cancer with curative intent, reducing the overall immunosuppressive load and/or switching to an alternative drug regimen may potentially be of great benefit to avoid cancer recurrence, but should be balanced against the risks of rejection and/or severe adverse events. The TLJ (Transplant Learning Journey) project is an initiative from the European Society for Organ Transplantation (ESOT). This article reports a systematic literature search undertaken by TLJ Workstream 3 to answer the questions: (1) Should we decrease the overall anti‐rejection therapy in potentially cured post‐kidney transplant cancer (excluding non‐melanoma skin cancer)? (2) Should we switch to mammalian target of rapamycin inhibitors (mTORi) in potentially cured post‐kidney transplant cancer (excluding non‐melanoma skin cancer)? The literature search revealed insufficient solid data on which to base recommendations, so this review additionally presents an extensive overview of the indirect evidence on the benefits versus risks of alterations in immunosuppressive medication. We hope this summary will help transplant physicians advise KTRs on how best to continue with anti‐rejection therapy after receiving cancer treatment with curative intent, and aid shared decision‐making, ensuring that patient preferences are taken into account.
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Affiliation(s)
- Rachel Hellemans
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
| | - Liset Pengel
- Centre of Evidence for Transplantation, Nuffield Department of Surgical Sciences, Oxford, UK
| | - Sylvain Choquet
- Service d'Hématologie, Hôpital Pitié Salpêtrière, Paris, France
| | - Umberto Maggiore
- Nephrology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
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29
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Buxeda A, Redondo-Pachón D, Pérez-Sáez MJ, Crespo M, Pascual J. Sex differences in cancer risk and outcomes after kidney transplantation. Transplant Rev (Orlando) 2021; 35:100625. [PMID: 34020178 DOI: 10.1016/j.trre.2021.100625] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023]
Abstract
Kidney transplant recipients (KTRs) experience a two- to four-fold increased risk of developing and dying from cancer compared with the general population. High cancer risk results from the interaction of both modifiable and non-modifiable factors. This mapping review explores the impact of sex disparity on cancer's increased incidence and mortality after kidney transplantation (KT). In terms of age, population-based studies indicate that younger recipients of both sexes experience a higher risk of cancer, but this is more pronounced in young women. On the contrary, older men are more likely to be diagnosed with cancer, although their increased risk is not statistically significant compared with the general population. Regarding cancer type, studies show an increased risk of Kaposi sarcoma, gynecologic and lung cancer in women, and bladder and kidney cancer in men. Immune-related cancers such as pos-transplant lymphoproliferative disorders and melanoma are increased in both sexes. Mortality also shows differences between sexes. Although cancer is the second cause of death in both male and female KTRs, studies show higher overall mortality in men and elderly recipients. However, the relative risk of cancer mortality compared with the general population is higher at a younger age, with disparate results regarding sex. Female KTRs appear to die at a younger age than males when compared with the general population. Differences in cancer rates by sex after renal transplantation need further studies. A better understanding of sex-specific differences in cancer epidemiology after KT could help nephrologists to better address pre-transplant counseling, to establish early surveillance programs, and to plan modifiable risk factors such as immunosuppression.
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Affiliation(s)
- Anna Buxeda
- Department of Nephrology, Hospital del Mar, Barcelona, Spain.
| | | | | | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Barcelona, Spain
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30
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Stefanopoulos S, Parsikia A, Kaissieh D, Sutton JM, Ortiz J. A Limitation of Administrative Datasets: Kidney Transplant Recipients Had Double the Incidence of Benign Pathology After Pancreatectomy. Pancreas 2021; 50:e32-e33. [PMID: 33835983 DOI: 10.1097/mpa.0000000000001764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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31
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Robinson CH, Coughlin CC, Chanchlani R, Dharnidharka VR. Post-transplant malignancies in pediatric organ transplant recipients. Pediatr Transplant 2021; 25:e13884. [PMID: 33111463 DOI: 10.1111/petr.13884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/13/2020] [Accepted: 09/24/2020] [Indexed: 12/11/2022]
Abstract
The majority of cancer diagnoses in pediatric solid organ transplant recipients (SOTRs) are post-transplantation lymphoproliferative disorders (PTLD) or skin cancers. However, pediatric SOTRs are also at significantly elevated risk for multiple other solid and hematological cancers. The risks of specific cancers vary by transplanted organ, underlying disease, and immunosuppression factors. More than one-quarter of pediatric SOTRs develop cancer within 30 years of transplantation and their risk of solid cancer is 14 times greater than the general population. Pediatric SOTRs are at significantly higher risk of cancer-associated death. Improving patient survival among pediatric SOTRs puts them at risk of adult epithelial cancers associated with environmental carcinogenic exposures. Vaccination against oncogenic viruses and avoidance of excessive immunosuppression may reduce the risk of solid cancers following transplantation. Patient and family education regarding photoprotection is an essential component of skin cancer prevention. There is significant variability in cancer screening recommendations for SOTRs and general population approaches are typically not validated for transplant populations. An individualized approach to cancer screening should be developed based on estimated cancer risk, patient life expectancy, and screening test performance.
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Affiliation(s)
- Cal H Robinson
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Carrie C Coughlin
- Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,ICES McMaster, Hamilton, ON, Canada
| | - Vikas R Dharnidharka
- Division of Pediatric Nephrology, Hypertension and Pheresis, Washington University School of Medicine, Saint Louis, MO, USA
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Culty T, Goujon A, Defortescu G, Bessede T, Kleinclauss F, Boissier R, Drouin S, Branchereau J, Doerfler A, Prudhomme T, Matillon X, Verhoest G, Tillou X, Ploussard G, Rozet F, Méjean A, Timsit MO. [Localized Prostate cancer in candidates for renal transplantation and recipients of a kidney transplant: The French Guidelines from CTAFU]. Prog Urol 2021; 31:4-17. [PMID: 33423746 DOI: 10.1016/j.purol.2020.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/13/2020] [Accepted: 04/20/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To define guidelines for the management of localized prostate cancer (PCa) in kidney transplant (KTx) candidates and recipients. METHOD A systematic review (Medline) of the literature was conducted by the CTAFU to report prostate cancer epidemiology, screening, diagnosis and management in KTx candidates and recipients with the corresponding level of evidence. RESULTS KTx recipients are at similar risk for PCa as general population. Thus, PCa screening in this setting is defined according to global French guidelines from CCAFU. Systematic screening is proposed in candidates for renal transplant over 50 y-o. PCa diagnosis is based on prostate biopsies performed after multiparametric MRI and preventive antibiotics. CCAFU guidelines remain applicable for PCa treatment in KTx recipients with some specificities, especially regarding lymph nodes management. Treatment options in candidates for KTx need to integrate waiting time and access to transplantation. Current data allows the CTAFU to propose mandatory waiting times after PCa treatment in KTx candidates with a weak level of evidence. CONCLUSION These French recommendations should contribute to improve PCa management in KTx recipients and candidates, integrating oncological objectives with access to transplantation.
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Affiliation(s)
- T Culty
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - A Goujon
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - G Defortescu
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - T Bessede
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de Bicêtre, université de Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - F Kleinclauss
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHRU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - R Boissier
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de La Conception, université Aix-Marseille, 47, boulevard Baille, 13005 Marseille, France
| | - S Drouin
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de la Pitié-Salpêtrière, université Paris Sorbonne, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - J Branchereau
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Nantes, 5, allée de l'Île-Gloriette, 44093 Nantes cedex 01, France
| | - A Doerfler
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Brugmann, place A. Van Gehuchten 4, 1020 Bruxelles, Belgique
| | - T Prudhomme
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, 9, place Lange, 31300 Toulouse, France
| | - X Matillon
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - G Verhoest
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - X Tillou
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - G Ploussard
- Comité de cancérologie de l'Association française d'urologie (CCAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - F Rozet
- Comité de cancérologie de l'Association française d'urologie (CCAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'urologie, institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie (CCAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - M-O Timsit
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; PARCC, INSERM, équipe labellisée par la Ligue Contre le Cancer, université de Paris, 56, rue Leblanc, 75015 Paris, France.
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Rosner MH, Jhaveri KD, McMahon BA, Perazella MA. Onconephrology: The intersections between the kidney and cancer. CA Cancer J Clin 2021; 71:47-77. [PMID: 32853404 DOI: 10.3322/caac.21636] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/12/2022] Open
Abstract
Onconephrology is a new subspecialty of nephrology that recognizes the important intersections of kidney disease with cancer. This intersection takes many forms and includes drug-induced nephrotoxicity, electrolyte disorders, paraneoplastic glomerulonephritis, and the interactions of chronic kidney disease with cancer. Data clearly demonstrate that, when patients with cancer develop acute or chronic kidney disease, outcomes are inferior, and the promise of curative therapeutic regimens is lessened. This highlights the imperative for collaborative care between oncologists and nephrologists in recognizing and treating kidney disease in patients with cancer. In response to this need, specific training programs in onconephrology as well as dedicated onconephrology clinics have appeared. This comprehensive review covers many of the critical topics in onconephrology, with a focus on acute kidney injury, chronic kidney disease, drug-induced nephrotoxicity, kidney disease in stem cell transplantation, and electrolyte disorders in patients with cancer.
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Affiliation(s)
- Mitchell H Rosner
- Division of Nephrology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Kenar D Jhaveri
- Division of Kidney Disease and Hypertension, Zucker School of Medicine at Hofstra University, Great Neck, New York
| | - Blaithin A McMahon
- Division of Nephrology. Medical, University of South Carolina, Charleston, South Carolina
| | - Mark A Perazella
- Division of Nephrology, Yale University School of Medicine, New Haven, Connecticut
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Thiem U, Buxhofer‐Ausch V, Kranewitter W, Webersinke G, Enkner W, Cejka D. Successful kidney transplantation in a patient with pre-existing chronic myeloid leukemia treated with imatinib. Am J Transplant 2021; 21:405-409. [PMID: 32654389 PMCID: PMC7818412 DOI: 10.1111/ajt.16194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/29/2020] [Accepted: 06/28/2020] [Indexed: 01/25/2023]
Abstract
Active malignancy is an absolute contraindication to kidney transplantation. As for chronic myeloid leukemia (CML), a Philadelphia chromosome-positive myeloproliferative neoplasm, the introduction of tyrosine kinase inhibitors has transformed CML from a lethal into a manageable chronic disease with a close-to-normal life expectancy. To date it is unknown whether kidney transplantation can be safely performed in patients with pre-existing CML. We describe the clinical course of a 57-year-old male patient with chronic kidney disease caused by reflux nephropathy. This patient had undergone first kidney transplantation 20 years earlier and had again been on chronic hemodialysis for 6 years when CML was diagnosed. First-line therapy with 400 mg imatinib daily was well tolerated and induced an optimal cytogenetic and molecular response 3 months after initiation. One and a half years after CML diagnosis, a second kidney transplantation from a deceased donor was performed. Immunosuppression included basiliximab, tacrolimus, mycophenolate mofetil, and corticosteroids. Currently, 2 years posttransplant, renal allograft function is stable (serum creatinine 1.09 mg/dL, estimated glomerular filtration rate 75 mL/min per 1.73 m2 ), and CML remains in deep molecular remission with imatinib. Imatinib-treated CML in deep molecular remission could be regarded as inactive malignancy and may therefore not be viewed as an absolute contraindication to kidney transplantation.
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Affiliation(s)
- Ursula Thiem
- Department of Nephrology and Hypertension DiseasesTransplantation Medicine and RheumatologyOrdensklinikum LinzKrankenhaus ElisabethinenLinzAustria,Faculty of MedicineJohannes Kepler University LinzLinzAustria
| | - Veronika Buxhofer‐Ausch
- Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical OncologyOrdensklinikum LinzKrankenhaus ElisabethinenLinzAustria
| | - Wolfgang Kranewitter
- Laboratory for Molecular Biology and Tumor CytogeneticsDepartment of Internal Medicine IOrdensklinikum LinzBarmherzige SchwesternLinzAustria
| | - Gerald Webersinke
- Laboratory for Molecular Biology and Tumor CytogeneticsDepartment of Internal Medicine IOrdensklinikum LinzBarmherzige SchwesternLinzAustria
| | - Wolfgang Enkner
- Department of Nephrology and Hypertension DiseasesTransplantation Medicine and RheumatologyOrdensklinikum LinzKrankenhaus ElisabethinenLinzAustria
| | - Daniel Cejka
- Department of Nephrology and Hypertension DiseasesTransplantation Medicine and RheumatologyOrdensklinikum LinzKrankenhaus ElisabethinenLinzAustria
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Fenoglio R, Roccatello D, De Simone E, Del Vecchio G, Ferro M, Quattrocchio G, Barreca A, Sciascia S. The Challenging Management of Cancer: An Immunonephrologist's Perspective. Kidney Blood Press Res 2020; 46:114-120. [PMID: 33326976 DOI: 10.1159/000511256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/31/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Onconephrology is an emerging medical subspecialization that focuses on the numberless interrelations between cancer and kidney diseases. Tumor cells evade immune surveillance through activation of immune checkpoint pathways that suppress antitumor immune responses. By blocking checkpoints, new anticancer agents disrupt immune homeostasis but potentially induce immune-mediated diseases. Nephrologists and nephroimmunologists should be able to treat the nephrotoxic sequelae of cancer therapy and ensure continuation of the life-saving treatment. METHODS Thirty-seven renal biopsies have been carried out over 42 months in oncologic patients, that is, 5.2% of the total native renal biopsies were carried out in the same period. The commonest diagnoses (>6 cases) were interstitial tubular nephritis, membranous glomerulopathy, IgA nephropathy, vasculitis, and focal and segmental glomerulosclerosis. CASE PRESENTATION Three example cases, including focusing on key questions which could involve the nephrologists are reported in detail. They include a cancer-related Goodpasture Syndrome, the peculiar toxic effects of pemetrexed on tubular cells, and the intriguing relationship between bevacizumab and cryoglobulinemic glomerulonephritis. CONCLUSION As shown by these 3 example cases, nephrologists need to be open-minded with regard to kidney biopsy in order to get a timely diagnosis. Nephrologists also need to improve their knowledge of cancer biology and therapy in order to prevent kidney problems, manage therapy-related immune-mediated disorders, and improve patient life expectancy.
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Affiliation(s)
- Roberta Fenoglio
- Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Dario Roccatello
- Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy,
| | - Emanuele De Simone
- Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giulio Del Vecchio
- Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Michela Ferro
- Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giacomo Quattrocchio
- Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Antonella Barreca
- Division of Pathology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Savino Sciascia
- Nephrology and Dialysis Unit & CMID (Center of Research of Immunopathology and Rare Diseases), Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital of Turin, and Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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Kang JJH, Bozso SJ, Boe DE, Al-Adra DP, Moon MC, Freed DH, Nagendran J, Nagendran J. Resveratrol attenuates stimulated T-cell activation and proliferation: potential therapy against cellular rejection in organ transplantation. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL IMMUNOLOGY 2020; 9:81-90. [PMID: 33489476 PMCID: PMC7811925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/18/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pharmaceuticals to inhibit mammalian target of rapamycin (mTOR) protein, which plays an integral role in T cell survival and function, have been used to prevent complications associated with organ transplantation. Although studies have individually shown that resveratrol can inhibit mTOR and that inhibiting mTOR leads to attenuated immune function, no studies to date have examined these two functions conjointly under one study. Therefore, we hypothesize that resveratrol will decrease mTOR activation and expression as well as attenuate stimulated T cell activation and proliferation in peripheral blood mononuclear cells (PBMC). METHODS AND MATERIALS Human PBMC were isolated and cultured. The cells were pre-treated with resveratrol (50 μM) overnight (18 hrs) before stimulation. The cells were collected for subsequent biochemical analysis after 1, 3, and 5 days. Additionally, the cells were stained with proliferation dye and cultured for 24 hours in PMA/Ionomycin with resveratrol for flow cytometry analysis. RESULTS Resveratrol treated stimulated PBMCs displayed a significant decrease in activated phosphorylation of mTOR at days 1, 3, and 5 (P < 0.0329). Markers of T cell activation, tumour necrosis factor-alpha (TNF-α) and interferon-gamma (INF-γ), were also significantly reduced along with T cell proliferation following stimulated PBMC resveratrol treatment when compared to vehicle-treated controls (P < 0.01). CONCLUSION Taken together, our data suggest that resveratrol can decrease the immune response of stimulated T-cells and inhibit the expression and activation of mTOR mediated cellular signalling under the same study setting. Therefore, resveratrol proposes a possible adjunctive therapy option for patients undergoing organ transplantation.
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Affiliation(s)
- Jimmy JH Kang
- Faculty of Medicine and Dentistry, University of AlbertaEdmonton, AB, Canada
| | - Sabin J Bozso
- Department of Surgery, Division of Cardiac Surgery, University of AlbertaEdmonton, AB, Canada
| | - Dana E Boe
- Faculty of Medicine and Dentistry, University of AlbertaEdmonton, AB, Canada
| | - David P Al-Adra
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public HealthMadison, WI, USA
| | - Michael C Moon
- Department of Surgery, Division of Cardiac Surgery, University of AlbertaEdmonton, AB, Canada
| | - Darren H Freed
- Department of Surgery, Division of Cardiac Surgery, University of AlbertaEdmonton, AB, Canada
| | - Jayan Nagendran
- Department of Surgery, Division of Cardiac Surgery, University of AlbertaEdmonton, AB, Canada
| | - Jeevan Nagendran
- Department of Surgery, Division of Cardiac Surgery, University of AlbertaEdmonton, AB, Canada
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Bachelet T, Visentin J, Davis P, Taton B, Guidicelli G, Kaminski H, Merville P, Couzi L. The incidence of post-transplant malignancies in kidney transplant recipients treated with Rituximab. Clin Transplant 2020; 35:e14171. [PMID: 33247459 DOI: 10.1111/ctr.14171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/01/2020] [Accepted: 11/19/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Rituximab has been proposed as induction therapy in kidney transplant recipients (KTRs) with preformed donor-specific antibodies (DSA) or a positive flow cross-match. We here evaluated whether adding rituximab was associated with a higher incidence of post-transplant malignancies (PTM) due to greater immunosuppression. PATIENTS AND METHODS Forty-eight HLA-sensitized KTRs received induction therapy with anti-thymocyte globulin (ATG) and rituximab because of preformed DSA or a positive flow cross-match (RTX group). They were compared with a control group of 154 patients receiving ATG alone. RESULTS Thirty-nine of 202 (19.3%) patients developed PTM; the rate was similar in the RTX and no-RTX groups (14.6% vs. 20.8%, respectively, P = .3). The distributions of the types of cancer were similar between the two groups, with the majority being non-melanoma skin cancer (NMSC, n = 24). The risk factors for PTM were male gender, age, history of cancer, and azathioprine. CONCLUSION Our data do not indicate a higher rate of post-transplantation de novo malignancies after kidney transplantation in high-immunological risk patients who received induction therapy based on ATG and rituximab.
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Affiliation(s)
- Thomas Bachelet
- Clinique Saint-Augustin-CTMR, Bordeaux, ELSAN, France.,Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France
| | - Jonathan Visentin
- Immunology and Immunogenetics Laboratory, Bordeaux University Hospital, Bordeaux, France.,ImmunoConcEpT UMR 5164, Bordeaux University, CNRS, Bordeaux, France
| | - Philippine Davis
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France
| | - Benjamin Taton
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France
| | - Gwendaline Guidicelli
- Immunology and Immunogenetics Laboratory, Bordeaux University Hospital, Bordeaux, France
| | - Hannah Kaminski
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France.,ImmunoConcEpT UMR 5164, Bordeaux University, CNRS, Bordeaux, France
| | - Pierre Merville
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France.,ImmunoConcEpT UMR 5164, Bordeaux University, CNRS, Bordeaux, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France.,ImmunoConcEpT UMR 5164, Bordeaux University, CNRS, Bordeaux, France
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Volovat SR, Volovat C, Miron I, Kanbay M, Goldsmith D, Lungulescu C, Badarau SC, Covic A. Oncogenic mechanisms in renal insufficiency. Clin Kidney J 2020; 14:507-515. [PMID: 33623673 PMCID: PMC7886561 DOI: 10.1093/ckj/sfaa122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 05/08/2020] [Indexed: 12/15/2022] Open
Abstract
The prevalence of both cancer and end-stage renal disease is increasing. In addition, medical advances have meant increased survival rates for both diseases. Many chemotherapeutics are renally excreted, and conversely, renal insufficiency promotes a pro-neoplastic state, including genitourinary and other cancers. Dialysis prolongs life while increasing cancer risk. Proposed oncogenic mechanisms include immune dysfunction, chronic inflammation, changes in gut microbiota and stimulation of the renin-angiotensin system. This review summarizes current concepts in the relationship between cancer and renal insufficiency.
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Affiliation(s)
- Simona Ruxandra Volovat
- Department of Medical Oncology, University of Medicine and Pharmacy 'Grigore T Popa', Iasi, Romania
| | - Constantin Volovat
- Department of Medical Oncology, University of Medicine and Pharmacy 'Grigore T Popa', Iasi, Romania
| | - Ingrith Miron
- Department of Medical Oncology, University of Medicine and Pharmacy 'Grigore T Popa', Iasi, Romania
| | - Mehmet Kanbay
- Department of Nephrology, Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - David Goldsmith
- Department of Nephrology, St George's University Hospital, London, UK
| | - Cristian Lungulescu
- Department of Medical Oncology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Silvia Corina Badarau
- Department of Medical Oncology, University of Medicine and Pharmacy 'Grigore T Popa', Iasi, Romania
| | - Adrian Covic
- Department of Medical Oncology, University of Medicine and Pharmacy 'Grigore T Popa', Iasi, Romania
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Rosner MH. Cancer Screening in Patients Undergoing Maintenance Dialysis: Who, What, and When. Am J Kidney Dis 2020; 76:558-566. [DOI: 10.1053/j.ajkd.2019.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/10/2019] [Indexed: 01/18/2023]
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40
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Waiting times in renal transplant candidates with a history of malignancy: time for a change? Curr Opin Nephrol Hypertens 2020; 29:623-629. [PMID: 32941190 DOI: 10.1097/mnh.0000000000000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW With the aging population of kidney transplant candidates, a history of malignancy is an increasingly prevalent finding. Tumors can constitute a contraindication for transplantation or can lead to a delay of acceptance to the waiting-list. Current waiting time guidelines mainly refer to early data collected nearly 30 years ago, when the knowledge on tumors was, by current standards, still limited. RECENT FINDINGS Today, cancers can usually be divided into many different biological subtypes, according to histological and molecular subclassification and the availability of genetic testing. A more precise stratification and targeted antitumor therapies have led to better therapy outcomes or even cures from certain malignancies and to a better appreciation of tumor risks for the patient. SUMMARY Even though transplant patients do have an increased risk for malignancies, it is often overlooked that patients, while on dialysis, are equally prone to develop a tumor. Competing risks (e.g. cardiovascular, mortality risks) through prolonged time on dialysis have to be equally considered, when the decision for acceptance of a patient to the waiting-list is made. Current waiting time suggestions should be critically reconsidered for every patient after a thorough discussion with an oncologist, including new diagnostic and therapeutic strategies, as well as novel risk stratifications.
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41
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Watschinger B, Budde K, Crespo M, Heemann U, Hilbrands L, Maggiore U, Mariat C, Oberbauer R, Oniscu GC, Peruzzi L, Sorensen SS, Viklicky O, Abramowicz D. Pre-existing malignancies in renal transplant candidates-time to reconsider waiting times. Nephrol Dial Transplant 2020; 34:1292-1300. [PMID: 30830155 DOI: 10.1093/ndt/gfz026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/24/2018] [Indexed: 12/12/2022] Open
Abstract
Current proposals for waiting times for a renal transplant after malignant disease may not be appropriate. New data on malignancies in end-stage renal disease and recent diagnostic and therapeutic options should lead us to reconsider our current practice.
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Affiliation(s)
- Bruno Watschinger
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Klemens Budde
- Department of Nephrology, Charité Medical University Berlin, Berlin, Germany
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain; Institute Mar for Medical Research, Parc de Salut Mar, Barcelona, Spain
| | - Uwe Heemann
- Department of Nephrology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Luuk Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Umberto Maggiore
- Department of Nephrology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Christophe Mariat
- Department of Nephrology, Dialysis, and Renal Transplantation, University North Hospital, Saint Etienne, France
| | - Rainer Oberbauer
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | | | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Children's Hospital, Turin, Italy
| | - Søren S Sorensen
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ondrej Viklicky
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital, Antwerp University, Antwerp, Belgium
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Flabouris K, Chadban S, Ladhani M, Cervelli M, Clayton P. Body mass index, weight-adjusted immunosuppression and the risk of acute rejection and infection after kidney transplantation: a cohort study. Nephrol Dial Transplant 2020; 34:2132-2143. [PMID: 31168571 DOI: 10.1093/ndt/gfz095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/15/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Body mass index (BMI) is associated with patient outcomes after kidney transplantation. We hypothesized that immunosuppression (IS) dosing is a contributing factor. METHODS Using Australia and New Zealand Dialysis and Transplant registry data, we included all adult kidney-only transplant recipients over 2000-14 treated with prednisolone, mycophenolate and tacrolimus/cyclosporin (n = 7919). The exposure was BMI and the outcomes were time to: (i) acute rejection, (ii) fatal infection, (iii) cancer and (iv) graft; and (v) patient survival. We modelled BMI and IS dosing (in quartiles) as time-varying covariates in extended Cox models. RESULTS Compared with a BMI of 25 kg/m2, a BMI of 35 was associated with acute rejection after adjusting for demographics and comorbidities [adjusted hazard ratio (aHR) = 1.29, 95% confidence interval (CI) 1.12-1.49]. This association virtually disappeared after correcting for IS (aHR = 1.09, 95% CI 0.93-1.29). A BMI of 35 was non-significantly associated with fewer fatal infections (aHR = 0.91, 95% CI 0.66-1.25), but this reversed after adjusting for IS (aHR = 1.54, 95% CI 1.03-2.28). Results for cancer were not significantly altered after adjusting for IS. Results for lower BMI were similarly not significantly altered though generally associated with worse outcomes. CONCLUSIONS Our findings show that the associations between high BMI, acute rejection and fatal infection after kidney transplantation were significantly altered after correcting for IS suggesting that relative under-dosing of obese patients may partially explain these associations.
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Affiliation(s)
- Katerina Flabouris
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Steven Chadban
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,School of Medicine, The University of Sydney, Camperdown, Australia.,Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Maleeka Ladhani
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,School of Medicine, The University of Sydney, Camperdown, Australia.,Department of Renal Medicine, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Matthew Cervelli
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Philip Clayton
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
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43
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Yasin S, Holley JL. When ESKD complicates cancer screening and cancer treatment. Semin Dial 2020; 33:236-244. [PMID: 32274869 DOI: 10.1111/sdi.12879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
End-stage kidney disease (ESKD) affects the recommended screening, incidence, treatment, and mortality of cancer. Cancer occurring in a patient with ESKD can influence candidacy for kidney transplantation as well as dialysis decision-making and cancer treatment. Certain cancers are more common among ESKD patients, notably, viral-mediated cancers that are associated with human papilloma or hepatitis viruses, and urothelial cancers associated with analgesic and Balkan nephropathies. Solid tumors are not believed to occur more frequently in ESKD patients. The presence of ESKD may confer a higher risk of post-surgical complications as well as mortality. The cost-effectiveness of cancer screening depends upon individual cancer risk and estimated overall survival. The high mortality associated with ESKD argues against routine cancer screening in dialysis patients. Cancer treatment in ESKD may be complicated by the need to avoid, adjust doses of and/or coordinate the timing of administration of imaging contrast, chemotherapy, and immunotherapy with dialysis treatments. There is a general dearth of information on the treatment of cancer in ESKD patients. These issues will be discussed, and some general guidelines presented based upon the current literature.
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Affiliation(s)
- Saddam Yasin
- Carle Foundation Hospital Internal Medicine Residency Program, Urbana, IL, USA
| | - Jean L Holley
- The University of Illinois College of Medicine, Urbana-Champaign and Carle Illinois College of Medicine, Urbana, IL, USA
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44
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Francis A, Johnson DW, Melk A, Foster BJ, Blazek K, Craig JC, Wong G. Survival after Kidney Transplantation during Childhood and Adolescence. Clin J Am Soc Nephrol 2020; 15:392-400. [PMID: 32075809 PMCID: PMC7057311 DOI: 10.2215/cjn.07070619] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/12/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Survival in pediatric kidney transplant recipients has improved over the past five decades, but changes in cause-specific mortality remain uncertain. The aim of this retrospective cohort study was to estimate the associations between transplant era and overall and cause-specific mortality for child and adolescent recipients of kidney transplants. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data were obtained on all children and adolescents (aged <20 years) who received their first kidney transplant from 1970 to 2015 from the Australian and New Zealand Dialysis and Transplant Registry. Mortality rates were compared across eras using Cox regression, adjusted for confounders. RESULTS A total of 1810 recipients (median age at transplantation 14 years, 58% male, 52% living donor) were followed for a median of 13.4 years. Of these, 431 (24%) died, 174 (40%) from cardiovascular causes, 74 (17%) from infection, 50 (12%) from cancer, and 133 (31%) from other causes. Survival rates improved over time, with 5-year survival rising from 85% for those first transplanted in 1970-1985 (95% confidence interval [95% CI], 81% to 88%) to 99% in 2005-2015 (95% CI, 98% to 100%). This was primarily because of reductions in deaths from cardiovascular causes (adjusted hazard ratio [aHR], 0.25; 95% CI, 0.08 to 0.68) and infections (aHR, 0.16; 95% CI, 0.04 to 0.70; both for 2005-2015 compared with 1970-1985). Compared with patients transplanted 1970-1985, mortality risk was 72% lower among those transplanted 2005-2015 (aHR, 0.28; 95% CI, 0.18 to 0.69), after adjusting for potential confounders. CONCLUSIONS Survival after pediatric kidney transplantation has improved considerably over the past four decades, predominantly because of marked reductions in cardiovascular- and infection-related deaths.
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Affiliation(s)
- Anna Francis
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia; .,Child and Adolescent Renal Service, Children's Health Queensland, South Brisbane, Queensland, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Queensland, Brisbane, Australia.,School of Medicine, Translational Research Institute, Queensland, Brisbane, Australia.,Department of Nephrology, Princess Alexandra Hospital, Queensland, Brisbane, Australia
| | - Anette Melk
- Department of Pediatric Nephrology, Hannover Medical School, Hannover, Germany
| | - Bethany J Foster
- Division of Nephrology, Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Katrina Blazek
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan C Craig
- School of Medicine, Flinders University, Adelaide, South Australia, Australia; and
| | - Germaine Wong
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia
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45
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Sexton DJ, O'Kelly P, O'Leary E, Murray S, Deady S, Daly F, Egan J, Houlihan DD, McCormick PA, Morris PG, Ni Raghallaigh S, Moloney FJ, O'Neill JP, Conlon PJ. Variation in Nonmelanoma Skin Cancer Incidence by Treatment Modality Among Patients Receiving Multiple Kidney Transplants. JAMA Dermatol 2020; 155:594-598. [PMID: 30725084 DOI: 10.1001/jamadermatol.2018.4660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Importance Existing data suggest that nonmelanoma skin cancer (NMSC) is more common in renal transplant recipients than in maintenance dialysis patients. However, whether the risk of NMSC varies as the treatment modality for end-stage kidney disease (ESKD) changes between dialysis and transplantation is not well described. Objective To determine whether the incidence of NMSC is attenuated during periods of graft loss with a return to dialysis in those who receive multiple kidney transplants. Design, Setting, and Participants Retrospective analysis of data from recipients of kidney transplants from the Irish National Kidney Transplant Service database, linked with the Irish Cancer Registry, from 1994 to 2014. All analysis took place between January 10, 2018 and March 31, 2018. Standardized incidence ratios (SIRs) were calculated for NMSC incidence in comparison with the general population using Irish census data as the denominator. Incidence of NMSC was calculated with modality of treatment for ESKD varying over time; incidence rates and rate ratios associated with dialysis intervals were calculated using Poisson regression; and disease was defined according to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for cancer diagnosis. Exposures Kidney transplantation. Main Outcomes and Measures Incidence rates per 1000 patient-years and incident rate ratios of NMSC after kidney transplant. Results Data from the records of 3821 deceased or living donor kidney transplant recipients were assessed; 2399 (62.8%) male and 1422 (37.2%) female recipients; mean (SD) age at time of first data recorded, 41.9 (16.0) years. A total of 3433 recipients were included who had a functioning transplant on January 1, 1994, or received a transplant after that date up to December 31, 2014: 3215 received 1 transplant, 522 a second kidney transplant, and 84 had 3 or more kidney transplants. Periods of treatment with a functioning transplant were associated with a higher incidence of NMSC diagnosis than periods of graft failure: adjusted incidence rate ratio (aIRR), 2.19 (95% CI, 1.56-3.07), P < .001. The aIRRs of NMSC fell from 41.7 (95% CI, 39.38-44.15) per 1000 patient-years in the first transplant to 19.29 (95% CI, 13.41-27.76) in the dialysis period following the first allograft failure. Incidence similarly rose and fell following each subsequent consecutive transplant. Conclusions and Relevance In recipients of multiple kidney transplants, while the incidence of NMSC fell during periods defined by transplant failure, there was residual elevated risk. While ascertainment bias may have contributed to the observed trends, the stagnant incidence of invasive cancer overall highlights the need for continued cancer surveillance during graft failure.
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Affiliation(s)
- Donal J Sexton
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Patrick O'Kelly
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital Dublin, Ireland
| | - Eamonn O'Leary
- National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland
| | - Susan Murray
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital Dublin, Ireland
| | - Sandra Deady
- National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland
| | - Fergus Daly
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital Dublin, Ireland
| | - Jim Egan
- National Lung Transplantation Center, Mater University Hospital, Dublin, Ireland
| | - Diarmaid D Houlihan
- National Liver Transplant Center, St Vincent's University Hospital, Dublin, Ireland
| | - P Aiden McCormick
- National Liver Transplant Center, St Vincent's University Hospital, Dublin, Ireland
| | | | | | - Fergal J Moloney
- Department of Dermatology, Mater Misericordiae University Hospital, University College Dublin, School of Medicine, Dublin, Ireland
| | - James Paul O'Neill
- Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Otolaryngology-Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Peter J Conlon
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
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46
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Management of Immunosuppression in Kidney Transplant Recipients Who Develop Malignancy. J Clin Med 2019; 8:jcm8122189. [PMID: 31835895 PMCID: PMC6947374 DOI: 10.3390/jcm8122189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 11/17/2022] Open
Abstract
The risk of cancer increases after transplantation. However, the consensus on immunosuppression (IS) adjustment after diagnosis of malignancy is lacking. Our study aims to assess the impact of IS adjustment on mortality of post-kidney transplant patients and allograft outcomes. We retrospectively reviewed the data in our center of 110 subjects. Our results showed IS dose adjustment was not statistically associated with mortality risk (HR 1.94, 95%CI 0.85–4.41, p = 0.12), and chemotherapy was the only factor that was significantly related to mortality (HR 2.3, 95%CI 1.21–4.35, p = 0.01). IS reduction was not statistically associated with worsening graft function (OR 3.8, 95%CI 0.77–18.71, p = 0.10), nor with graft survival (SHR 4.46, 95%CI 0.58–34.48, p = 0.15) after variables adjustment. Creatinine at cancer diagnosis and history of rejection were both negatively associated with graft survival (SHR 1.72, 95%CI 1.28–2.30, p < 0.01 and SHR 3.44, 95%CI 1.25–9.49, p = 0.02). Reduction of both mycophenolate and calcineurin inhibitors was associated with worsening graft function and lower graft survival in subgroup analysis (OR 6.14, 95%CI 1.14–33.15, p = 0.04; HR 17.97, 95%CI 1.81–178.78, p = 0.01). In summary, cancer causes high mortality and morbidity in kidney transplant recipients; the importance of cancer screening should be emphasized.
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47
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Malyszko J. Post-transplant lymphoproliferative disorder: risk factors and management. Nephrol Dial Transplant 2019; 36:gfz207. [PMID: 31598720 DOI: 10.1093/ndt/gfz207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland
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48
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Lim WH, Johnson DW, McDonald SP, Hawley C, Clayton PA, Jose MD, Wong G. Impending challenges of the burden of end-stage kidney disease in Australia. Med J Aust 2019; 211:374-380.e3. [PMID: 31595516 DOI: 10.5694/mja2.50354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
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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Affiliation(s)
- Wai H Lim
- Sir Charles Gairdner Hospital, Perth, WA
| | - David W Johnson
- Princess Alexandra Hospital, Brisbane, QLD.,Centre for Health Services Research, University of Queensland, Brisbane, QLD
| | - Stephen P McDonald
- South Australian Health and Medical Research Institute, ANZDATA Registry, Adelaide, SA.,University of Adelaide, Adelaide, SA
| | - Carmel Hawley
- Princess Alexandra Hospital, Brisbane, QLD.,Centre for Health Services Research, University of Queensland, Brisbane, QLD
| | - Philip A Clayton
- South Australian Health and Medical Research Institute, ANZDATA Registry, Adelaide, SA
| | - Matthew D Jose
- University of Tasmania, Hobart, TAS.,Royal Hobart Hospital, Hobart, TAS
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49
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O'Neill JP, Sexton DJ, O'Leary E, O'Kelly P, Murray S, Deady S, Daly F, Williams Y, Dean B, Fitzgerald C, Murad A, Mansoor N, O'Neill JO, Egan J, Houlihan DD, McCormick PA, Morris PG, Ni Raghallaigh S, Little D, Moloney FJ, Conlon PJ. Post-transplant malignancy in solid organ transplant recipients in Ireland, The Irish Transplant Cancer Group. Clin Transplant 2019; 33:e13669. [PMID: 31310037 DOI: 10.1111/ctr.13669] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 06/09/2019] [Accepted: 06/26/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Solid organ transplant recipients are at increased risk of cancer compared to the general population. To date, this risk in Ireland has not been investigated. We conducted a national registry study of cancer incidence following solid organ transplantation. METHODS National centers for solid organ transplantation supplied their respective registry databases to cross-reference with episodes of malignancy from the National Cancer Registry Ireland (NCRI) between 1994 and 2014. Standardized incidence of cancer post-transplant was compared to the general population by means of standardized incidence ratios (SIRs), and between solid organ transplant types by incidence rate ratios. RESULTS A total of 3346 solid organ transplant recipients were included in this study. Kidney transplant recipients constituted the majority of participants (71.2%), followed by liver (16.8%), heart (6.4%), and lung (5.6%) transplants. The most common cancers within the composite of all transplant recipients included the following (SIR [95% CI]): squamous and basal cell carcinoma (20.05 [17.97, 22.31] and 7.16 [6.43, 7.96], respectively), non-Hodgkin lymphoma (6.23 [4.26, 8.59]), and renal cell carcinoma (3.36 [1.96, 5.38]). CONCLUSIONS This study reports the incidence of cancer following solid organ transplantation in Ireland. These results have significant national policy implications for surveillance, and early diagnosis in this patient group.
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Affiliation(s)
- James Paul O'Neill
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital & The Royal College of Surgeons in Ireland, Dublin, Ireland.,Royal College of Surgeons Ireland, Dublin, Ireland
| | - Donal J Sexton
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | | | - Patrick O'Kelly
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | - Susan Murray
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | | | - Fergus Daly
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | - Yvonne Williams
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | - Ben Dean
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | - Conall Fitzgerald
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital & The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aizuri Murad
- Department of Dermatology, School of Medicine, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Nazish Mansoor
- Department of Dermatology, School of Medicine, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Jim O O'Neill
- National Heart Transplant Center, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jim Egan
- National Lung Transplantation Center, Mater University Hospital Dublin, Dublin, Ireland
| | - Diarmaid D Houlihan
- National Liver Transplant Center, St Vincent's University Hospital, Dublin, Ireland
| | - P Aiden McCormick
- National Liver Transplant Center, St Vincent's University Hospital, Dublin, Ireland
| | - Patrick G Morris
- Royal College of Surgeons Ireland, Dublin, Ireland.,Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | - Dilly Little
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | - Fergal J Moloney
- Department of Dermatology, School of Medicine, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Peter J Conlon
- Royal College of Surgeons Ireland, Dublin, Ireland.,Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
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50
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Abstract
Cancer is the second most common cause of mortality and morbidity in kidney transplant recipients after cardiovascular disease. Kidney transplant recipients have at least a twofold higher risk of developing or dying from cancer than the general population. The increased risk of de novo and recurrent cancer in transplant recipients is multifactorial and attributed to oncogenic viruses, immunosuppression and altered T cell immunity. Transplant candidates and potential donors should be screened for cancer as part of the assessment process. For potential recipients with a prior history of cancer, waiting periods of 2-5 years after remission - largely depending on the cancer type and stage of initial cancer diagnosis - are recommended. Post-transplantation cancer screening needs to be tailored to the individual patient, considering the cancer risk of the individual, comorbidities, overall prognosis and the screening preferences of the patient. In kidney transplant recipients diagnosed with cancer, treatment includes conventional approaches, such as radiotherapy and chemotherapy, together with consideration of altering immunosuppression. As the benefits of transplantation compared with dialysis in potential transplant candidates with a history of cancer have not been assessed, current clinical practice relies on evidence from observational studies and registry analyses.
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Affiliation(s)
- Eric Au
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - Germaine Wong
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jeremy R Chapman
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia.
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