Renal Cell Carcinoma in End-Stage Kidney Disease and the Role of Transplantation

Simple Summary This review aims to characterize the unique presentation of renal cell carcinoma (RCC) in kidney transplant patients with end-stage kidney disease (ESKD). RCC in the ESKD patient is an ambiguous and under-studied area of oncology, as dialysis and transplantation alter the biological environment of the kidney. Assessing outcomes and dictating management for RCC in this anomalous patient population pose oncologic challenges, and thus warrant a review to update clinicians. The potential for donor tissue to cause cancer in the organ recipient is unknown, but one can assume that this risk is minimal. Our review challenges this concept and we propose new insights into how donor and recipient environments might influence the risk of cancer in the transplant recipient.Abstract Kidney transplant patients have a higher risk of renal cell carcinoma (RCC) compared to non-transplanted end-stage kidney disease (ESKD) patients. This increased risk has largely been associated with the use of immunosuppression; however, recent genetic research highlights the significance of tissue specificity in cancer driver genes. The implication of tissue specificity becomes more obscure when addressing transplant patients, as two distinct metabolic environments are present within one individual. The oncogenic potential of donor renal tissue is largely unknown but assumed to pose minimal risk to the kidney transplant recipient (KTR). Our review challenges this notion by examining how donor and recipient microenvironments impact a transplant recipient's associated risk of renal cell carcinoma. In doing so, we attempt to encapsulate how ESKD-RCC and KTR-RCC differ in their incidence, pathogenesis, outcome, and approach to management.