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J. Clin. Med. 2019, 8(4), 530; https://doi.org/10.3390/jcm8040530

Incidence and Mortality of Renal Cell Carcinoma after Kidney Transplantation: A Meta-Analysis

1
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
2
Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10300, Thailand
3
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
4
Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA
5
Division of Nephrology, Department of Medicine, Deaconess Health System, Evansville, IN 47747, USA
6
Department of Internal Medicine, East Tennessee State University, Johnson City, TN 37614, USA
7
Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand
8
Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY 13326, USA
9
Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, MS 39216, USA
10
Department of Nephrology, Department of Medicine, Saint Luke's Health System, Kansas City, MO 64111, USA
11
Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL 32224, USA
12
Department of Nephrology, Department of Medicine, Henry Ford Hospital , Detroit, MI 48202, USA
*
Author to whom correspondence should be addressed.
Received: 31 March 2019 / Revised: 13 April 2019 / Accepted: 15 April 2019 / Published: 17 April 2019
(This article belongs to the Special Issue Recent Advances and Clinical Outcomes of Kidney Transplantation)
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Abstract

Background: The incidence and mortality of renal cell carcinoma (RCC) after kidney transplantation (KTx) remain unclear. This study's aims were (1) to investigate the pooled incidence/incidence trends, and (2) to assess the mortality/mortality trends in KTx patients with RCC. Methods: A literature search was conducted using the MEDLINE, EMBASE and Cochrane databases from inception through October 2018. Studies that reported the incidence or mortality of RCC among kidney transplant recipients were included. The pooled incidence and 95% CI were calculated using a random-effect model. The protocol for this meta-analysis is registered with PROSPERO; no. CRD42018108994. Results: A total of 22 observational studies with a total of 320,190 KTx patients were enrolled. Overall, the pooled estimated incidence of RCC after KTx was 0.7% (95% CI: 0.5–0.8%, I2 = 93%). While the pooled estimated incidence of de novo RCC in the native kidney was 0.7% (95% CI: 0.6–0.9%, I2 = 88%), the pooled estimated incidence of RCC in the allograft kidney was 0.2% (95% CI: 0.1–0.4%, I2 = 64%). The pooled estimated mortality rate in KTx recipients with RCC was 15.0% (95% CI: 7.4–28.1%, I2 = 80%) at a mean follow-up time of 42 months after RCC diagnosis. While meta-regression analysis showed a significant negative correlation between year of study and incidence of de novo RCC post-KTx (slopes = −0.05, P = 0.01), there were no significant correlations between the year of study and mortality of patients with RCC (P = 0.50). Egger's regression asymmetry test was performed and showed no publication bias in all analyses. Conclusions: The overall estimated incidence of RCC after KTX was 0.7%. Although there has been a potential decrease in the incidence of RCC post-KTx, mortality in KTx patients with RCC has not decreased over time.
Keywords: malignancy; post-transplant malignancy; renal cell carcinoma; meta-analysis; kidney transplantation; transplantation; systematic reviews malignancy; post-transplant malignancy; renal cell carcinoma; meta-analysis; kidney transplantation; transplantation; systematic reviews
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Chewcharat, A.; Thongprayoon, C.; Bathini, T.; Aeddula, N.R.; Boonpheng, B.; Kaewput, W.; Watthanasuntorn, K.; Lertjitbanjong, P.; Sharma, K.; Torres-Ortiz, A.; Leeaphorn, N.; Mao, M.A.; Khoury, N.J.; Cheungpasitporn, W. Incidence and Mortality of Renal Cell Carcinoma after Kidney Transplantation: A Meta-Analysis. J. Clin. Med. 2019, 8, 530.

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