Association of Acute Rejection and De Novo Renal Cell Carcinoma in Kidney Transplant Patients: An OPTN Data Analysis

Background: Kidney Transplant Recipients (KTRs) are at risk of renal cell carcinoma (RCC). The risk of RCC in KTRs is approximated to be 5–10 times higher compared with the general population. A relation between kidney rejection and renal malignancy has been described and relates to the effect of immunosuppression at the genomic level. We decided to investigate any suggestive clinical evidence of this in the OPTN database. Methods: KTRs with de novo RCC between July 2004 and June 2022 were identified. Demographics, baseline characteristics, virology, and immunology data were compared between patients with and without RCC. Our follow-up period was four hundred (400) days. A multivariate regression analysis of the data was conducted. Results: In a total of 215,928 kidney transplant recipients, we identified 839 cases of RCC (0.39%). On multivariate analysis, patients who experienced acute rejection both before hospital discharge (OR 1.559; p = 0.037) and during the follow-up period (OR 1.448; p = 0.002) showed a statistically significant increased risk of developing RCC. Conclusions: Our study is an analysis of a large cohort of KTRs diagnosed with RCC. We observed that RCC appeared more frequently in the kidney transplant recipients that were complicated by acute rejection during transplant admission or follow-up period.