Renal neoplasias in patients receiving dialysis and renal transplantation: clinico-pathological features and p53 gene mutations.
BACKGROUND
In Japan, the relative risk for renal cell carcinoma (RCC) in renal transplants was about 80-fold higher than that in the general population. Depressed immune surveillance due to the use of immunosuppressive agents was considered to cause cancer. Before renal transplantation, a vast majority of patients received hemodialysis, a known causative factor for acquired cystic disease of kidney (ACDK). Because ACDK is also considered to predispose to RCC, at least two risk factors for cancer accumulate in renal transplants.


METHODS
In our study, clinicopathological features together with p53 gene mutations were analyzed in 218 patients with RCC: 22 received dialysis followed by renal transplantation, 39 received dialysis alone, and 157 sporadic RCC. P53 mutations were analyzed on DNA extracted from paraffin-embedded specimens with use of single strand conformation polymorphism, followed by direct sequencing.


RESULTS
RCC in transplants shared several clinicopathological features with those in dialysis patients, which included small size and multiplicity of tumor, relatively high frequency of presence of ACDK, and papillary type of RCC. p53 gene mutations were infrequent in RCC of any clinical setting.


CONCLUSIONS
Atrophic kidney at the end-stage of renal failure and under dialysis have lesions of ACDK that might predispose to RCC in dialysis and transplant patients.
Hoshida
Y
Y
Department of Pathology, Osaka University Medical School, Suita, Japan.
Nakanishi
H
H
Shin
M
M
Satoh
T
T
Hanai
J
J
Aozasa
K
K
D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery / Q000628:therapy*; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D016158:Genes, p53 / Q000235:genetics*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D007680:Kidney Neoplasms / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009154:Mutation; D016133:Polymerase Chain Reaction; D018807:Polymorphism, Single-Stranded Conformational; D006435:Renal Dialysis; D017422:Sequence Analysis, DNA
D007166:Immunosuppressive Agents; D016572:Cyclosporine