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

Xiaowei Hao; Wenhui Lai; Xinze Xia; Junnan Xu; Yangyang Wu; Chao Lv; Kaikai Lv; Shuai Huang; Zhenjun Luo; Qingyang Meng; Qing Yuan; Jun Dong

doi:10.3389/fonc.2022.955771

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

Front Oncol. 2022 Sep 29:12:955771. doi: 10.3389/fonc.2022.955771. eCollection 2022.

Authors

Xiaowei Hao¹, Wenhui Lai^{1

2}, Xinze Xia^{1

3}, Junnan Xu¹, Yangyang Wu¹, Chao Lv¹, Kaikai Lv¹, Shuai Huang^{1

2}, Zhenjun Luo^{1

4}, Qingyang Meng¹, Qing Yuan¹, Jun Dong¹

Affiliations

¹ Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China.
² Department of Postgraduate, Hebei North University, Zhangjiakou, China.
³ Department of Urology, Shanxi Medical University, Taiyuan, China.
⁴ Affiliated Hospital of Weifang Medical University, School of Clinical Medicine, Weifang Medical University, Weifang, China.

Abstract

Purpose: The incidence of end-stage renal disease (ESRD) caused by renal cell carcinoma (RCC) is increasing with the high prevalence of RCC as well as those with treatment-related renal function impairment. Worries about tumor recurrence after transplant-related immunosuppression hinder the recommendation of kidney transplantation for RCC-induced ESRD patients. However, no direct analysis has been performed to identify whether kidney transplantation can offer better survival than maintaining dialysis.

Materials and methods: This retrospective population-based cohort study was based on Organ Procurement and Transplantation Network data released in March 2021. Characteristics and outcomes were compared, including the patient and graft survival of candidates and recipients with RCC-induced ESRD etiology as well as other primary diseases.

Results: Patients with RCC-induced ESRD were older; more likely to be male, White, and obese; and more likely to have a history of diabetes and dialysis. They also had higher creatinine levels, more delayed graft function, more primary non-function, and higher Kidney Donor Profile Index score donors, compared with the glomerulonephritis (GN) group. While waiting, RCC candidates suffered the worst outcomes of all groups, a 44% (adjusted hazard ratio [aHR], 1.44 [1.27-1.62]) higher risk of removal than GN patients. After transplantation, RCC recipients demonstrated comparable patient survival and better graft survival (p=0.21 and p=0.13, respectively). Compared with still-waiting RCC patients, the RCC recipients who received kidney transplants had significantly better outcomes (13.6 [9.3-17.8] vs. 61 [52-68.4] %), decreasing the death or deteriorating risk by 84% (aHR, 0.16 [0.13-0.20]).

Conclusions: Patients with RCC-induced ESRD can dramatically benefit from kidney transplantation. Hence, these patients should not be limited to transplantation by strict strategies or a delayed waiting time out of their malignancy history.

Keywords: UNOS/OPTN; end-stage renal disease; kidney transplantation; propensity score match; renal cell carcinoma.