scholarly journals Propensity-Matched Survival Analysis of Upper Urinary Tract Urothelial Carcinomas between End-Stage Renal Disease with and without Kidney Transplantation

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Hao Lun Luo ◽  
Po Hui Chiang ◽  
Yuan Tso Cheng ◽  
Yen Ta Chen
Keyword(s):  
Kidney Transplantation ◽  
Urinary Tract ◽  
Propensity Score ◽  
Urothelial Carcinoma ◽  
End Stage Renal Disease ◽  
Upper Urinary Tract ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Urinary Tract Urothelial Carcinoma

Urothelial carcinoma is the most common cancer following kidney transplantation (KT) in Taiwan. Unusual presentation of upper urinary tract urothelial carcinoma (UTUC) is noted in Taiwan and China. As the post-KT-UTUC oncological course is not fully understood, the aim of this study is to identify postulated significant differences for the clinical cancer course of UTUC among end-stage renal disease (ESRD) patients with and without KT. From 2005 January to 2016 March, 194 ESRD patients underwent radical nephroureterectomy due to UTUC in our hospital. The parameters were obtained from the chart record and pathology report. SPSS version 21 software was used for all statistical analyses. Unequal matching created study groups wherein a 0.2 caliper width was performed for adjusting these confounding pathological factors. Propensity score-matching cohort was performed for each population first, and then for all the study patients. We observed that the average age of UTUC in ESRD patients after KT was younger than in those without KT. The pathological factors such as stage, bladder cancer history, papillary structure, lymphovascular invasion, and variant histology were equal in these two groups. However, younger onset (p<0.001), more multifocal tumors, and carcinomas in situ were observed in post-KT UTUC (p<0.001 and 0.006, respectively). After adjustment of pathological factors by propensity score-matched analysis, the 5-year systemic UTUC recurrence was significantly more in ESRD after KT compared with ESRD without KT (p=0.03). No obvious difference in 5-year cancer related death could be observed between these two groups (p=0.314). Post-kidney transplantation upper urinary tract urothelial carcinoma in Taiwan is relatively common, has younger onset, and is associated with aggressive pathological features. The oncologic outcome of UTUC after KT is poor in our observation, even after propensity scored-matched analysis. It indicates the immunosuppression status is still associated with more malignant UTUC behavior.

scholarly journals Propensity Score-Matched Analysis of the Survival Benefit from Kidney Transplantation in Patients with End-Stage Renal Disease

2018 ◽  
Vol 7 (11) ◽  
pp. 388
Author(s):  
Ming-Ju Wu ◽  
Tung-Min Yu ◽  
Cheng-Li Lin ◽  
Chia-Hung Kao
Keyword(s):  
Kidney Transplantation ◽  
Propensity Score ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Survival Outcome ◽  
Research Database ◽  
Newly Diagnosed ◽  
Dialysis Patients ◽  
Stage Renal Disease ◽  
End Stage

Background: Several comparison studies have suggested that kidney transplantation (KT) could reduce mortality in patients with end-stage renal disease (ESRD). Selection criteria bias is common in the selection of dialysis patients for control groups. In this study, we compared the survival outcome between KT recipients and comparable propensity score-matched dialysis patients. Methods: We used Taiwan’s National Health Insurance Research Database to identify patients newly diagnosed with ESRD between 2000 and 2010. We separated them into two groups: a KT group and non-KT dialysis-only group. To evaluate the survival outcome, we compared each patient with KT to a patient on dialysis without KT using propensity score matching. Results: In total, 1276 KT recipients and 1276 propensity score-matched dialysis patients were identified. Compared with the propensity score-matched dialysis patients, the patients who underwent KT exhibited significantly higher 5-year and 10-year survival rates (88% vs. 92% and 74% vs. 87%, both p < 0.05). The crude and adjusted hazard ratios for mortality were 0.55 and 0.52 in patients with KT (both p < 0.001). Mortality was insignificantly higher for patients who were on dialysis for longer than 1 year prior to KT compared with those on dialysis for less than 1 year. Conclusion: This study used a propensity score-matched cohort to confirm that KT is associated with lower risk of mortality than dialysis alone in patients newly diagnosed with ESRD.

scholarly journals Nationwide Glaucoma incidence in end stage renal disease patients and kidney transplant recipients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jong Joo Moon ◽  
Yong Woo Kim ◽  
Baek-Lok Oh ◽  
Kyungdo Han ◽  
Dong Ki Kim ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Open Angle Glaucoma ◽  
Angle Closure ◽  
Healthy Controls ◽  
Kidney Transplant Recipients ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

AbstractGlaucoma shares common risk factors with chronic kidney disease (CKD) but previous cross-sectional studies have demonstrated discrepancies in the risk of glaucoma in CKD patients. This study enrolled kidney transplantation recipients (KTRs) (n = 10,955), end stage renal disease (ESRD) patients (n = 10,955) and healthy controls (n = 10,955) from National Health Insurance Service database of the Republic of Korea. A Cox proportional hazard regression model was used to calculate the hazard ratios (HR) for primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) incidences. The incidence of POAG was higher in ESRD patients (3.36/1,000 person-years, P < 0.0001) and KTRs (3.22 /1,000 person-years, P < 0.0001), than in healthy controls (1.20/1,000 person-years). However, POAG risk showed no significant increase in either ESRD patients (P = 0.07) or KTRs (P = 0.08) when adjusted for the confounding factors. The incidence of PACG was significantly higher in ESRD patients (0.41/1,000 person-years) than in healthy controls (0.14/1,000 person-years, P = 0.008). The PACG incidence was significantly lower in KTRs than in ESRD patients (HR = 0.35, P = 0.015). In conclusion, this nationwide cohort study demonstrated that kidney transplantation can reduce the risk of PACG but not POAG in ESRD patients.

scholarly journals Native Kidney Hydronephrosis Is Associated with Upper Urinary Tract Urothelial Carcinoma in Post-Kidney Transplantation Patients

2021 ◽  
Vol 10 (19) ◽  
pp. 4474
Author(s):  
Cheng-Ju Ho ◽  
Yu-Hui Huang ◽  
Tzuo-Yi Hsieh ◽  
Min-Hsin Yang ◽  
Shao-Chuan Wang ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Kidney Transplantation ◽  
Urinary Tract ◽  
Urothelial Carcinoma ◽  
Female Gender ◽  
Upper Urinary Tract ◽  
Native Kidney ◽  
Kaplan Meier ◽  
Bilateral Lesions ◽  
Urinary Tract Urothelial Carcinoma

Background: Upper urinary tract urothelial carcinoma (UTUC) is the most common malignancy occurring after kidney transplantation (KT) in Taiwan. The aim of this study was to investigate the association between native kidney hydronephrosis and UTUC in post-KT patients. Methods: From 2003 to 2018, we conducted a retrospective cohort study that enrolled 1005 post-KT patients, 67 of whom were subsequently diagnosed with UTUC. We divided patients into two groups based on whether or not they had UTUC. Multivariate analysis and Kaplan-Meier plot were used to evaluate if native kidney hydronephrosis was associated with post-KT UTUC. Results: The total cohort consisted of 612 men (60.9%) and 393 women (39.1%) with a mean age of 48.2 ± 12.0 at KT. The mean follow-up time was 118.6 ± 70.2 months, and mean time from KT to UTUC was 7.53 years. There was a significant gender difference with a female predominance among the UTUC patients (73.1% versus 26.9%, p < 0.001). Native kidney hydronephrosis occurred more frequently in the UTUC group (68.7% versus 4.8%, p < 0.001). Multivariate analysis showed that native kidney hydronephrosis and female gender were significantly associated with UTUC with odds ratios of 35.32 (95% CI, 17.99–69.36; p < 0.001) and 3.37 (95% CI, 1.55–7.29; p = 0.002), respectively. UTUC in the post-KT patients also showed aggressive pathological characteristics and a tendency toward bilateral lesions (41.8%). Conclusions: Native kidney hydronephrosis is significantly associated with post-KT UTUC patients in Taiwan. Native kidney hydronephrosis may be a deciding factor for standard nephroureterectomy and bladder cuff excision in selected patients. Nevertheless, almost half of the patients with kidney hydronephrosis do not present with UTUC at the end of our study.

scholarly journals The Prognostic Impact of Tumor Architecture for Upper Urinary Tract Urothelial Carcinoma: A Propensity Score-Weighted Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Hui-Ying Liu ◽  
Yen Ta Chen ◽  
Shun-Chen Huang ◽  
Hung-Jen Wang ◽  
Yuan-Tso Cheng ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Propensity Score ◽  
Urothelial Carcinoma ◽  
Propensity Score Analysis ◽  
Histological Grade ◽  
Upper Urinary Tract ◽  
Lymph Node Status ◽  
Prognostic Impact ◽  
Cancer Specific Survival ◽  
Urinary Tract Urothelial Carcinoma

PurposeTo assess the association of tumor architecture with cancer recurrence, metastasis, and cancer-specific survival (CSS) in patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC) in Taiwan.Materials and MethodsData were collected from 857 patients treated with RNU between January 2005 and August 2016 in our hospital. Pathologic slides were reviewed by genitourinary pathologists. Propensity score weighting was performed for data analysis.ResultsSessile growth pattern was observed in 212 patients (24.7%). Tumor architecture exhibited a significant association with bladder cancer history, chronic kidney disease (CKD), tumor stage, lymph node status, histological grade, lymphovascular invasion, concomitant carcinoma in situ, and the variant type [standardized mean difference (SMD) &gt; 0.1 for all variables before weighting]. In the propensity score analysis, 424 papillary and sessile tumor architecture were analyzed to balance the baseline characteristics between the groups. Tumor architecture was an independent predictor of metastatic disease and CSS (p = 0.033 and p = 0.002, respectively). However, the associations of tumor architecture with bladder and contralateral recurrence were nonsignificant (p = 0.956 and p = 0.844, respectively).ConclusionsTumor architecture of UTUC after RNU is associated with established features of aggressive disease and predictors of metastasis and CSS. Assessment of tumor architecture may help identify patients who could benefit from close follow-up or early administration of systemic therapy after RNU. Tumor architecture should be included in UTUC staging after further confirmation.

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