Incidence of Renal Cell Carcinoma after Solid Organ Transplantation: a Systematic Review and Meta-analysis

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To identify the risk of renal cell carcinoma (RCC) after liver, kidney, heart and lung transplantation, respectively, a combined meta-analysis has been conducted. Methods: Three databases were searched from inception until May 2022. Retrospective and cohort studies which focus on the statistical data of standardized incidence ratios (SIRs) of RCC after SOT more than one year have been included and extracted. The study was registered with PROSPERO, CRD4202022343633. Results: Sixteen original studies have been included for meta-analysis. Liver transplantation could increase the risk of RCC (SIR=0.73, 95%CI: 0.53 to 0.93) with no heterogeneity( P =0.594, I 2 =0.0%). And kidney transplantation could increase the risk of RCC(8.54, 6.68 to 10.40; 0.000,90.0%). Besides, heart and lung transplantation also could increase the risk of RCC(SIR=0.73, 95%CI: 0.53 to 0.93; SIR=1.61, 95%CI:0.50 to 2.71). Moreover, significance could also be found in most subgroups, especially the European group and retrospective study group. What’s more, after removing studies which have a greater impact on the overall outcome in RCC rate after kidney transplantation, heterogeneity did not solve and significant different was also observed in the European group (7.15, 5.49 to 8.81; 0.000, 78.6%). Conclusion: Liver, kidney, heart and lung transplantation patients have an increased risk of processing RCC compared to the general population and most subgroups, especially in geographic location of European subgroup. Incidence of renal cell carcinoma Solid organ transplantation Malignant incidence Systematic review Meta-analysis Figures Figure 1 Figure 2 Figure 3 Introduction Although solid organ transplantation (SOT) has been the most useful alternative therapeutic strategy for solid-organ diseases nowadays[ 1 ], which offers life-saving treatment for end-stage diseases considered terminal or those associated with a premonitory impairment in patients’ quality of life. Although immunosuppression therapy has also seen advantages with the expansion of immunosuppressive protocols to dampen the host immune response and improve short and long-term graft survival, which is accompanied by the risk of developing a postoperative malignant tumor[ 1 – 2 ], and the incidence of malignant tumors after SOT is 2–5 times that of the normal population[ 3 – 4 ]. Therefore, we need to conduct a combined analysis on the incidence of malignant tumors after important SOT. Immunosuppressive therapy after transplantation reduces transplant recipients' ability to control virus infections, thus exposing the recipients to increase risk of infection-associated cancers[ 5 ]. Moreover, the use of immunosuppressive agents to prevent allograft rejection increases the long-term risk of malignant tumor. Among the risks of solid tumors after transplantation, renal cell carcinoma (RCC) is the most common type. The cause may be driven primarily by kidney failure-related factors, with immunosuppression contributing to a lesser degree[ 6 – 7 ]. So we determine to research the effect of important SOT on the incidence rate of RCC. In this systematic review and meta-analysis, we determine to identify the risk of RCC after liver, kidney, heart and lung transplantation, respectively. None of previous systematic review[ 8 ] has provided a comprehensive overview with meta-analysis and meta-regression which to evaluate the transplant population most likely to progress to RCC. Materials And Methods This systematic review and meta-analysis followed systematic reviews and meta-analyses (PRISMA) guideline[ 9 ] and registered with International prospective register of systematic reviews(PROSPERO) website (NO. CRD4202022343633)[ 10 ]. Search strategy and eligibility criteria We meticulously searched electronic databases of PubMed, Embase and the Cochrane Library from their inception until May 2022, with keywords of organ transplantation, incidence of renal cell carcinoma and their MeSH terms. Studies which focus on the statistical data of standardized incidence ratios (SIRs) of RCC after SOT more than one year have been included and extracted. Research type of either retrospective study or cohort study with no language restriction. Transplantation types include kidney, liver, heart and lung transplantation have been included, and no restrictions on nationality, region, time of transplants or follow-up time. The search process was performing by two independent researches (WY and LYN), and the controversy and disagreement have been resolved by the third experienced review(GHF or ZYS). Besides, the reference lists of relevant meta-analysis was also identified for potential eligible publications. Data collection and risk of bias For each eligible study, the above pairs of researches extracted data independently using a standardized table. Baseline characteristic of first author, publication year, region, research type, research period, research design, number of transplant recipients, age, gender, follow-up period and incidence cases of RCC. For outcomes in this systematic review and meta-analysis, only SIR data with combined effect size model have been extracted. Moreover, subgroups analysis were grouping by transplant type (liver transplantation, kidney transplantation, heart transplantation, lung transplantation), geographic location (Europe, Asia, North America) and research type (retrospective study, cohort study). And the quality of eligible studies was assessed using the Newcastle-Ottawa Scale (NOS) score[ 11 ], and the score greater than 4 is acceptable. We also used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) scales[ 12 ] to evaluate the quality of the outcomes from standard meta-analysis. All the above procedures were evaluated by two research separately, and disagreement have been discussion. Data synthesis and analysis For combined effect size pairwise meta-analysis, in order to avoid homogeneity between included studies, random-effect models were used. And the heterogeneity among studies were assessed by P -value and I 2 statistic, and P -values less than 0.05 or I 2 more than 50% indicated heterogeneity in these outcome[ 13 ]. And, SIR data with their 95% credible intervals (95%CI) upper and lower limits have been extracted. Moreover, we take the natural logarithm of the above data and then merge them to avoid discrepancies in the data. Besides, the P value from meta-regression was used to determine whether the factor was the source of heterogeneity, P value less than 0.05 proved existences[ 14 – 15 ]. Moreover, the Begg’s and Egger’s test were used to assess the publication bias for available comparisons, P value less than 0.05 means yes. All the aforementioned analyses were performed using StataSE version 15.1. Results Description of included studies The electronic database search yielded 2622 unique publications, after screening by titles, 61 publications were left for checking. Then moving researches with no incidence of RCC, non-solid transplantation and case analysis, 25 publications were left for full-text checking. Later, studies of sub-type of RCC, no-extractable data available and researches between different sexes have been excluded. Ultimately, 16 original studies[ 16 – 31 ] have been included for meta-analysis, eleven of them reported incidence RCC data of liver transplant, kidney transplant (n = 11), heart transplant (n = 6) and lung transplant (n = 3)(Fig. 1 ). And seven of them were retrospective study, 9 of them were cohort study; the sample size was from 280 to 102654; the baseline characteristic of incidence of RCC risk after transplantation were summarized in Table 1 . The quality of all included studies was itemized in Table S1, they all scored 7–8 scales which were acceptable. Table 1 Baseline characteristic of incidence of kidney cancer risk after transplantation Study, year Region Research type Research period Research design Number of transplant recipients Age,gender(male%) Follow-up period(year) Incidence cases of kidney cancer Friman TK,2022[ 16 ] Finland Retrospective study 1987–2016 Liver transplantation 1078 49.8(36–58),49% 8.1(0−30.9) 7 Kidney transplantation 4514 49.5(37–59),64% 9.6(0−30.9) 90 Heart transplantation 599 50.3(37–57),75% 8.3(0−29.6) 11 Lung transplantation 280 53.2(43–61),58% 4.5(0−25.8) 2 Leon-Rodriguez E,2020[ 17 ] Mexico Retrospective study 1967–2015 Kidney transplantation 1404 36.5(16–70),58.2% 15(0–43) 8 Yeh CC,2020[ 18 ] Taiwan Retrospective study 1997–2011 Liver transplantation 2127 45.5,71.6% 5.9(3.8) Kidney transplantation 5038 44.4,52.9% 6.6(3.6) Heart transplantation 687 46,79.8% 5.9(3.8) Lengwiler E,2019[ 19 ] Switzerland Cohort study 2008–2014 Kidney transplantation 1557 53.9 (41.7–62.9),64.9 3.3(1.6−5) -- O'Neill JP,2019[ 20 ] Ireland Retrospective study 1994–2014 Liver transplantation 562 48.5(15.7–70.7),54.1% -- 2 Kidney transplantation 2382 43.02(1.42–77.43),62.7% -- 11 Heart transplantation 214 47.09(40.77–57.55),77.6% -- 4 Heo J,2017[ 21 ] South Korea Retrospective study 1994–2014 Liver transplantation 2462 53,81.9% 12.4M(0.8–53.0) 3 Kaneko J,2013[ 22 ] Japanese Cohort study 1996–2012 Liver transplantation 360 49,53.3% 7.5 ± 3.4 2 Krynitz B,2013[ 23 ] Swedish Cohort study 1970–2008 Liver transplantation 1221 49(36–57),57% 5(0–21) 2 Kidney transplantation 7952 47(35–57),62% 8(0–38) 70 Heart transplantation 1012 50(38–57),61% 5(0–23) 1 Piselli P,2013[ 24 ] Italy Cohort study 1997–2009 Kidney transplantation 7217 -,64.2% 5.2(2.9–7.8) 36 Schrem H,2013[ 25 ] Germany Retrospective study 1983–2010 Liver transplantation 2000 36.7(0–71), 53.3% 7.25 7 Cheung CY,2012[ 26 ] China Hongkang Retrospective study 1972–2011 Kidney transplantation 4895 43.7 ± 12.6, 58.6% 4.8 26 Engels EA,2011[ 27 ] USA Cohort study 1987–2008 Liver transplantation 37888 47,60.9% 1 Kidney transplantation 102654 565 Heart transplantation 17981 85 Lung transplantation 7013 8 Collett D,2010[ 28 ] UK Cohort study 1980–2007 Liver transplantation 6846 −.52% Kidney transplantation 25104 −.62% Heart transplantation 3609 −.80% Lung transplantation 2058 −.53% Aberg F,2008[ 29 ] Finland Cohort study 1982–2005 Liver transplantation 540 43 ± 18, 45% 6.3y(0–24) 2 Jiang Y,2008[ 30 ] Canada Cohort study 1983–1998 Liver transplantation 2034 40–70,62% 42.2 ± 33.8m 4 Villeneuve PJ,2007[ 31 ] Canada Cohort study 1981–1998 Kidney transplantation 11155 −.63.2% - 71 Incidence of renal cell carcinoma risk after transplantation Table 2 and Fig. 1 summarized total data and subgroup analysis from original studies of the incidence of RCC in the liver, kidney, heart, and lung transplant patients. We can notice that in the first section, liver transplant could significant increase incident rate of RCC(SIR = 0.73, 95%CI: 0.53 to 0.93) with no heterogeneity( P = 0.594, I 2 = 0.0%), and the publication bias could be tested from the Egger’s test( P = 0.036), and the GRADE assessment was low grade. Besides, significance could also be found in geographic locations of Europe (0.91, 0.50 to 1.32) and Asia (0.93, 0.27 to 1.59) subgroups, and research type of both retrospective study (1.89, 1.46 to 2.31) and cohort study (2.07, 0.88 to 3.26), with low heterogeneity, moderate grade and no publication bias. Table 2 Incidence of renal cell carcinoma which subgroup analyzed by transplant type, region and research type. Transplant type Study(patients) SIR(95%CI) Heterogeneity Meta-regression Publication bias Grade Liver Transplantation Total 11(57118) 0.73 (0.53, 0.93)* 0.594, 0.0% 0.876, 0.036 ¶ Low Geographic location Europe 6(12247) 0.91(0.50, 1.32)* 0.906, 0.0% 0.945 0.851, 0.784 Moderate Asia 4(42837) 0.93(0.27,1.59)* 0.158,42.2% 0.497, 0.353 Moderate North America 1(2034) 1.13(−0.01, 2.28) - - Research type Retrospective study 6(46117) 1.89(1.46, 2.31)* 0.767,0.0% 0.561 0.851, 0.218 Moderate Cohort study 5(11001) 2.07(0.88, 3.26)* 0.861,0.0% 0.624, 0.270 Moderate Kidney Transplantation Total 11(173872) 8.54(6.68, 10.40)* 0.000,90.0% # 0.881, 0.393 Low Geographic location Europe 6(48726) 6.43(4.55, 8.31)* 0.000,82.2% # 0.285 0.348, 0.805 Low Asia 3(112587) 18.50(4.33, 32.68)* 0.000,97.1% # 0.602, 0.508 Low North America 2(12559) 11.57(−0.19,23.33) 0.085,66.3% # 0.317,- Very low Research type Retrospective study 6(120887) 11.85(7.82,15.89)* 0.000, 94.2% # 0.519 0.573, 0.468 Low Cohort study 5(52985) 6.83(5.23, 8.43)* 0.008, 71.0% # 0.624, 0.654 Low Heart Transplantation Total 6(24102) 3.37(2.02, 4.71)* 0.209, 30.2% 0.748, 0.276 Moderate Geographic location Europe 4(5434) 4.17(1.49, 6.85)* 0.119, 48.7% 0.047 & 1.000, 0.798 Moderate Asia 2(18668) 2.89(2.26, 3.53)* 0.834, 0.0% 0.317,- Low Research type Retrospective study 4(19481) 3.93(1.58, 6.28)* 0.237, 29.2% 0.842 1.000, 0.389 Moderate Cohort study 2(4621) 2.93(−0.29, 6.14) 0.091, 64.9% # 0.317,- Low Lung Transplantation Total 3(9351) 1.61 (0.50, 2.71)* 0.649, 0.0% 1.000, 0.312 Low For SIR of RCC after kidney transplantation, significant different could be found in overall (8.54, 6.68 to 10.40), geographic location of Europe (6.43, 4.55 to 8.31) and Asia (18.50, 4.33 to 32.68) subgroups, retrospective study (11.85, 7.82 to 15.89) and cohort study (6.83, 5.23 to 8.43). Strangely, there was substantial heterogeneity within overall and all subgroups, and no source of heterogeneity was determined by meta-analysis. Therefore, sensitivity analysis was done for further analysis. From the outcome of sensitivity analysis, we found that the researches of Yeh CC(2020) and Engels EA(2011) may have a greater impact on the overall outcome (Fig. 3 A). Subsequently, significance could be found in overall after the adjustment also with substantial heterogeneity (7.15, 5.49 to 8.81; 0.000, 78.6%; Fig. 3 B), and geographic location of Europe (6.43, 4.55 to 8.31; 0.000, 82.2%). For incident risk of RCC after heart transplantation, significance could be found in overall(3.37, 2.02 to 4.71), geographic location of Europe (4.17, 1.49 to 6.85) and Asia (2.89, 2.26 to 3.53) subgroups and retrospective study (3.93, 1.58 to 6.28), with low heterogeneity and low-moderate grade. Besides, meta-regression detected different geographic regions may influence the existence of heterogeneity( P = 0.047). For the risk of RCC after lung transplantation, significant different with no heterogeneity could be found (1.61, 0.50 to 2.71). In summary, the incident of RCC risk could increased after solid organ transplantation, especially in the European subgroup. Discussion This research followed standard PRISMA statement and registered with PROSPERO website. First, 16 original studies[ 16 – 31 ] were yield through the layers processing, 11of them provided SIR and their 95% data of liver transplantation, 11 of them provide data of kidney transplantation, 6 of them in heart transplantation and 3 of them with data of lung transplantation(Table 1 , Fig. 1 ). Second, from pairwise meta-analysis, incident of RCC risk could increase from liver, kidney, heart and lung transplantation, and significance could find in most subgroups (Table 2 , Fig. 2 ). Besides, meta-regression showed that grouping by geographic location maybe the source of heterogeneity. Third, sensitivity analysis determine that Yeh CC and Engels EA may had great influence on overall outcome of incident risk of RCC. After removing them, we could notice that SOT increase risk of RCC mainly in Europe group (Fig. 3 ). From our research, although the incidence rate of RCC will increase after SOT, we also found that the incidence rate RCC after kidney transplantation is higher (8.54, 6.68 to 10.40) than that of incidence rate such as liver, heart and lung transplantation. Moreover, we do not know what causes the clinical heterogeneity among adjustment forest. Kidney transplant recipients have at least a 2–5 fold higher risk of developing or dying from malignant tumor than the general population. The increased risk of primary and recurrence cancer in transplant recipients is complex and attributed to oncogenic viruses, immunosuppression and altered T cell immunity[ 32 ]. The cause of heterogeneity may include different immunosuppressive agents, dose regimens, duration, etc. Immunosuppressant medication promotes impaired immunosurveillance, activation of oncogenic viruses, and have carcinogenic effects[ 33 – 34 ]. Different studies have described an increased risk of RCC development in patients with chronic kidney disease (CKD). As a results of the chronic uremic state in patients and other former risk factors associated with both CKD and malignancy[ 35 – 36 ]. Nowadays, risk factors for cancer-based on recipient characteristics known a pre-exist at the time of transplantation, such as sex differences that have not been well explored. And many medical disciplines have shown increasing awareness of how diseases manifest differently in men and women, trends in age-standardized cancer incidence rates differ by sex, being stable in men and increasing slightly among women during the most recent five years[ 37 – 38 ]. The mechanism of incident of RCC, immunosuppressive agents could induce carcinogenesis by reducing immunosurveillance and mechanisms involved in the immunologic control of oncogenic viral infection or direct deoxyribonucleic acid (DNA) damage. However, the therapeutic effect of each drug on RCC development remains controversial because of the use of multi-agent therapy regimens. The increased risk of RCC may be mediated by the overall or cumulative exposure to immunosuppression more than by the agent itself[ 33 – 34 ]. There are also some limitations among our study. First, only 16 publications have been included into meta-analysis, and for the incident risk of RCC after heart and lung transplantation, only 6 and 3 articles have been included, the results from meta-analysis may not be accurate enough. Second, the subgroup analysis only grouped by geographic location (Europe, Asia, North America) and research type (retrospective study, cohort study). As for the incidence rate of RCC, the baseline difference in follow-up time is huge, and some original studies do not report the follow-up time, so it is difficult for us to conduct subgroup analysis. Third, we only did sensitivity analysis for renal transplantation which with higher heterogeneity. After sensitivity analysis, the heterogeneity among the studies was still large, which may be the impact of clinical heterogeneity of incidence RCC rate. In summary, the results of this systematic review and meta-analysis suggest that liver, kidney, heart and lung transplantation patients have an increased risk of processing RCC compared to the general population and most subgroups, especially in geographic location of European subgroup. Future patients-based retrospective and cohort study are required to explore the potential clinical risk factors associated with incident risk of RCC. Declarations Acknowledgements Not applicable. Funding None. Availability of data and materials All data generated or analysed during this study are included in this published article and its supplementary information files. Authors’ contributions WY, LYN, ZYS: Conceptualization. WY, LYN, GHF, SF, SHW: Data curation; Formal analysis; Methodology. LDS: Supervision. WY, LYN, ZYS: Writing - original draft. WY, LYN, GHF, SF, SHW, ZYS: Writing - review & editing. Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations References Black CK, Termanini KM, Aguirre O, Hawksworth JS, Sosin M. Solid organ transplantation in the 21st century. Ann Transl Med. 2018;6(20):409. doi: 10.21037/atm.2018.09.68 . Buell JF, Gross TG, Woodle ES. Malignancy after transplantation. 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Supplementary Files Data.xls TableS1NOS.doc Cite Share Download PDF Status: Published Journal Publication published 06 Jan, 2024 Read the published version in BMC Urology → Version 1 posted Editorial decision: Major revision 30 Mar, 2023 Reviews received at journal 22 Mar, 2023 Reviews received at journal 03 Jan, 2023 Reviewers agreed at journal 03 Jan, 2023 Reviewers agreed at journal 29 Dec, 2022 Reviewers invited by journal 29 Dec, 2022 Editor assigned by journal 29 Dec, 2022 Editor invited by journal 26 Dec, 2022 Submission checks completed at journal 26 Dec, 2022 First submitted to journal 18 Oct, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2178376","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":162950045,"identity":"ebd38fe5-805a-4899-a33a-41fdbba52591","order_by":0,"name":"Yang Wang","email":"","orcid":"","institution":"First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Clinical Research Center for Kidney Diseases","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Wang","suffix":""},{"id":162950046,"identity":"f4da0690-7a26-4c74-80fb-19e946a2cec9","order_by":1,"name":"Yannan Li","email":"","orcid":"","institution":"Shenyang Pharmaceutical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yannan","middleName":"","lastName":"Li","suffix":""},{"id":162950047,"identity":"953e77c8-436e-4014-bae5-7f7c7cb392b2","order_by":2,"name":"Hefeng Geng","email":"","orcid":"","institution":"Shenyang Pharmaceutical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hefeng","middleName":"","lastName":"Geng","suffix":""},{"id":162950048,"identity":"1327bcd2-5dc3-4358-960a-3694c6a12166","order_by":3,"name":"Fang Sun","email":"","orcid":"","institution":"The Fifth Medical Center of Chinese PLA General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fang","middleName":"","lastName":"Sun","suffix":""},{"id":162950049,"identity":"01a20254-d8a0-48af-b6ed-515168246258","order_by":4,"name":"Huiwei Sun","email":"","orcid":"","institution":"The Fifth Medical Center of Chinese PLA General Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Huiwei","middleName":"","lastName":"Sun","suffix":""},{"id":162950050,"identity":"9bb971b0-be3d-461a-ac44-24bc20319edd","order_by":5,"name":"Yingshi Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIiWNgGAWjYDACCTjJw3D4R4WNHBt7+wEStDCcSTPm4zmTQIwWBrAWZsa2Q4nzJBwM8OqQn9387OHXNos8ef+zBw8XsB1Ib5NgSGD4UbENpxbGOcfMjWXbJIoNb+QlHJ7Bcye3TbrxAGPPmds4tTBLJJhJS7ZJJG6cwWNwgEfiWW6bzIEEoAtxa2GTSP8G0dJ/BqjF4HA6m0SCAV4tPBI5ZpIfgVrmM+QYHOZJOJxAUIuERE6ZNMM5icQNEjkGB2ccSDNsAwbyQXx+kZ+Rvk3yR1ld4vz+M8YfPv6zkZdvbz/44EcFbi3gIOBlY2AwOIAkcgCHSjhg/PEHaF0DIWWjYBSMglEwYgEAbMFbo2LAcHQAAAAASUVORK5CYII=","orcid":"","institution":"Shenyang Pharmaceutical University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yingshi","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2022-10-18 09:44:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2178376/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2178376/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12894-023-01389-1","type":"published","date":"2024-01-06T15:01:19+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":31033648,"identity":"b53c9a3b-0753-42f3-94b9-be6eed1d9760","added_by":"auto","created_at":"2023-01-03 15:26:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":109112,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow chat of screening including original studies in meta-analysis.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"OnlineFigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-2178376/v1/626d9eda7be3910d69e5cabe.png"},{"id":31036188,"identity":"311dec61-f5e4-4115-ba80-a9e4cd1dcdf2","added_by":"auto","created_at":"2023-01-03 15:42:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":121377,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest funnel of renal cell carcinoma incidence after liver transplantation(A), kidney transplantation(B), heart transplantation(C), lung transplantation(D).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"OnlineFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-2178376/v1/61d36a7b89543f386b3741ee.png"},{"id":31033652,"identity":"94844039-1648-4574-b53d-98a29ce23cb7","added_by":"auto","created_at":"2023-01-03 15:26:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":173766,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSensitivity analysis of renal cell carcinoma (A) and forest funnel of renal cell carcinoma incidence after kidney transplantation after remove Yeh CC and Engels EA (B)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"OnlineFigure3.png","url":"https://assets-eu.researchsquare.com/files/rs-2178376/v1/5a7f75aaac07966b8025062d.png"},{"id":49315678,"identity":"fb64b41d-30df-468a-8f2c-6b076a393bbd","added_by":"auto","created_at":"2024-01-08 15:09:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":947854,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2178376/v1/14b86029-aafe-4c39-815e-7e43de26baee.pdf"},{"id":31035157,"identity":"5763659e-e2d2-484e-9e7e-3fa69d70787b","added_by":"auto","created_at":"2023-01-03 15:34:00","extension":"xls","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":32768,"visible":true,"origin":"","legend":"","description":"","filename":"Data.xls","url":"https://assets-eu.researchsquare.com/files/rs-2178376/v1/13943d0be0bca7b00eac2077.xls"},{"id":31033651,"identity":"cfb07c08-8570-41f3-828a-50fe9c414bae","added_by":"auto","created_at":"2023-01-03 15:26:00","extension":"doc","order_by":9,"title":"","display":"","copyAsset":false,"role":"supplement","size":42496,"visible":true,"origin":"","legend":"","description":"","filename":"TableS1NOS.doc","url":"https://assets-eu.researchsquare.com/files/rs-2178376/v1/d0720c61dbe8f356edee74ea.doc"}],"financialInterests":"No competing interests reported.","formattedTitle":"Incidence of Renal Cell Carcinoma after Solid Organ Transplantation: a Systematic Review and Meta-analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAlthough solid organ transplantation (SOT) has been the most useful alternative therapeutic strategy for solid-organ diseases nowadays[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], which offers life-saving treatment for end-stage diseases considered terminal or those associated with a premonitory impairment in patients\u0026rsquo; quality of life. Although immunosuppression therapy has also seen advantages with the expansion of immunosuppressive protocols to dampen the host immune response and improve short and long-term graft survival, which is accompanied by the risk of developing a postoperative malignant tumor[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], and the incidence of malignant tumors after SOT is 2\u0026ndash;5 times that of the normal population[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, we need to conduct a combined analysis on the incidence of malignant tumors after important SOT.\u003c/p\u003e \u003cp\u003eImmunosuppressive therapy after transplantation reduces transplant recipients' ability to control virus infections, thus exposing the recipients to increase risk of infection-associated cancers[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Moreover, the use of immunosuppressive agents to prevent allograft rejection increases the long-term risk of malignant tumor. Among the risks of solid tumors after transplantation, renal cell carcinoma (RCC) is the most common type. The cause may be driven primarily by kidney failure-related factors, with immunosuppression contributing to a lesser degree[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. So we determine to research the effect of important SOT on the incidence rate of RCC.\u003c/p\u003e \u003cp\u003eIn this systematic review and meta-analysis, we determine to identify the risk of RCC after liver, kidney, heart and lung transplantation, respectively. None of previous systematic review[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] has provided a comprehensive overview with meta-analysis and meta-regression which to evaluate the transplant population most likely to progress to RCC.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003eThis systematic review and meta-analysis followed systematic reviews and meta-analyses (PRISMA) guideline[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and registered with International prospective register of systematic reviews(PROSPERO) website (NO. CRD4202022343633)[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSearch strategy and eligibility criteria\u003c/h2\u003e \u003cp\u003eWe meticulously searched electronic databases of PubMed, Embase and the Cochrane Library from their inception until May 2022, with keywords of organ transplantation, incidence of renal cell carcinoma and their MeSH terms. Studies which focus on the statistical data of standardized incidence ratios (SIRs) of RCC after SOT more than one year have been included and extracted. Research type of either retrospective study or cohort study with no language restriction. Transplantation types include kidney, liver, heart and lung transplantation have been included, and no restrictions on nationality, region, time of transplants or follow-up time. The search process was performing by two independent researches (WY and LYN), and the controversy and disagreement have been resolved by the third experienced review(GHF or ZYS). Besides, the reference lists of relevant meta-analysis was also identified for potential eligible publications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData collection and risk of bias\u003c/h2\u003e \u003cp\u003eFor each eligible study, the above pairs of researches extracted data independently using a standardized table. Baseline characteristic of first author, publication year, region, research type, research period, research design, number of transplant recipients, age, gender, follow-up period and incidence cases of RCC. For outcomes in this systematic review and meta-analysis, only SIR data with combined effect size model have been extracted. Moreover, subgroups analysis were grouping by transplant type (liver transplantation, kidney transplantation, heart transplantation, lung transplantation), geographic location (Europe, Asia, North America) and research type (retrospective study, cohort study). And the quality of eligible studies was assessed using the Newcastle-Ottawa Scale (NOS) score[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and the score greater than 4 is acceptable. We also used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) scales[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] to evaluate the quality of the outcomes from standard meta-analysis. All the above procedures were evaluated by two research separately, and disagreement have been discussion.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData synthesis and analysis\u003c/h2\u003e \u003cp\u003eFor combined effect size pairwise meta-analysis, in order to avoid homogeneity between included studies, random-effect models were used. And the heterogeneity among studies were assessed by \u003cem\u003eP\u003c/em\u003e-value and \u003cem\u003eI\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e statistic, and \u003cem\u003eP\u003c/em\u003e-values less than 0.05 or \u003cem\u003eI\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e more than 50% indicated heterogeneity in these outcome[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. And, SIR data with their 95% credible intervals (95%CI) upper and lower limits have been extracted. Moreover, we take the natural logarithm of the above data and then merge them to avoid discrepancies in the data. Besides, the \u003cem\u003eP\u003c/em\u003e value from meta-regression was used to determine whether the factor was the source of heterogeneity, \u003cem\u003eP\u003c/em\u003e value less than 0.05 proved existences[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Moreover, the Begg\u0026rsquo;s and Egger\u0026rsquo;s test were used to assess the publication bias for available comparisons, \u003cem\u003eP\u003c/em\u003e value less than 0.05 means yes. All the aforementioned analyses were performed using StataSE version 15.1.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eDescription of included studies\u003c/h2\u003e \u003cp\u003eThe electronic database search yielded 2622 unique publications, after screening by titles, 61 publications were left for checking. Then moving researches with no incidence of RCC, non-solid transplantation and case analysis, 25 publications were left for full-text checking. Later, studies of sub-type of RCC, no-extractable data available and researches between different sexes have been excluded. Ultimately, 16 original studies[\u003cspan additionalcitationids=\"CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] have been included for meta-analysis, eleven of them reported incidence RCC data of liver transplant, kidney transplant (n\u0026thinsp;=\u0026thinsp;11), heart transplant (n\u0026thinsp;=\u0026thinsp;6) and lung transplant (n\u0026thinsp;=\u0026thinsp;3)(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). And seven of them were retrospective study, 9 of them were cohort study; the sample size was from 280 to 102654; the baseline characteristic of incidence of RCC risk after transplantation were summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The quality of all included studies was itemized in Table S1, they all scored 7\u0026ndash;8 scales which were acceptable.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristic of incidence of kidney cancer risk after transplantation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy, year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResearch type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eResearch period\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eResearch design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNumber of transplant recipients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAge,gender(male%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFollow-up period(year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIncidence cases of kidney cancer\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFriman TK,2022[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFinland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1987\u0026ndash;2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiver transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e49.8(36\u0026ndash;58),49%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.1(0\u0026minus;30.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKidney transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4514\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e49.5(37\u0026ndash;59),64%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.6(0\u0026minus;30.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHeart transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e50.3(37\u0026ndash;57),75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.3(0\u0026minus;29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLung transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e53.2(43\u0026ndash;61),58%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.5(0\u0026minus;25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeon-Rodriguez E,2020[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMexico\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1967\u0026ndash;2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKidney transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36.5(16\u0026ndash;70),58.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15(0\u0026ndash;43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYeh CC,2020[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTaiwan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1997\u0026ndash;2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiver transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e45.5,71.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.9(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKidney transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e44.4,52.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.6(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHeart transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e46,79.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.9(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLengwiler E,2019[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSwitzerland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCohort study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2008\u0026ndash;2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKidney transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e53.9 (41.7\u0026ndash;62.9),64.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.3(1.6\u0026minus;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eO'Neill JP,2019[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIreland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1994\u0026ndash;2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiver transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e562\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e48.5(15.7\u0026ndash;70.7),54.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKidney transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e43.02(1.42\u0026ndash;77.43),62.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHeart transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e47.09(40.77\u0026ndash;57.55),77.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeo J,2017[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouth Korea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1994\u0026ndash;2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiver transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2462\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e53,81.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12.4M(0.8\u0026ndash;53.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKaneko J,2013[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJapanese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCohort study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1996\u0026ndash;2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiver transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e49,53.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKrynitz B,2013[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSwedish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCohort study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1970\u0026ndash;2008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiver transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e49(36\u0026ndash;57),57%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5(0\u0026ndash;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKidney transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7952\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e47(35\u0026ndash;57),62%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8(0\u0026ndash;38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHeart transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e50(38\u0026ndash;57),61%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5(0\u0026ndash;23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePiselli P,2013[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCohort study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1997\u0026ndash;2009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKidney transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-,64.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.2(2.9\u0026ndash;7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchrem H,2013[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGermany\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1983\u0026ndash;2010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiver transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36.7(0\u0026ndash;71), 53.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCheung CY,2012[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChina Hongkang\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1972\u0026ndash;2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKidney transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4895\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e43.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6, 58.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEngels EA,2011[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCohort study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1987\u0026ndash;2008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiver transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e37888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e47,60.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKidney transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e102654\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e565\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHeart transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17981\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLung transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollett D,2010[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCohort study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1980\u0026ndash;2007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiver transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6846\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;.52%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKidney transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;.62%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHeart transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3609\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;.80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLung transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAberg F,2008[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFinland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCohort study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1982\u0026ndash;2005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiver transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e43\u0026thinsp;\u0026plusmn;\u0026thinsp;18, 45%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.3y(0\u0026ndash;24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJiang Y,2008[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCohort study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1983\u0026ndash;1998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiver transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40\u0026ndash;70,62%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e42.2\u0026thinsp;\u0026plusmn;\u0026thinsp;33.8m\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVilleneuve PJ,2007[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCohort study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1981\u0026ndash;1998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKidney transplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;.63.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eIncidence of renal cell carcinoma risk after transplantation\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cb\u003eand\u003c/b\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarized total data and subgroup analysis from original studies of the incidence of RCC in the liver, kidney, heart, and lung transplant patients. We can notice that in the first section, liver transplant could significant increase incident rate of RCC(SIR\u0026thinsp;=\u0026thinsp;0.73, 95%CI: 0.53 to 0.93) with no heterogeneity(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.594, \u003cem\u003eI\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.0%), and the publication bias could be tested from the Egger\u0026rsquo;s test(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036), and the GRADE assessment was low grade. Besides, significance could also be found in geographic locations of Europe (0.91, 0.50 to 1.32) and Asia (0.93, 0.27 to 1.59) subgroups, and research type of both retrospective study (1.89, 1.46 to 2.31) and cohort study (2.07, 0.88 to 3.26), with low heterogeneity, moderate grade and no publication bias.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIncidence of renal cell carcinoma which subgroup analyzed by transplant type, region and research type.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransplant type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudy(patients)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSIR(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHeterogeneity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMeta-regression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePublication bias\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eGrade\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiver Transplantation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(57118)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.73 (0.53, 0.93)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.594, 0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.876, 0.036\u003csup\u003e\u0026para;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGeographic location\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEurope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(12247)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.91(0.50, 1.32)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.906, 0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.851, 0.784\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(42837)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.93(0.27,1.59)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.158,42.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.497, 0.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorth America\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(2034)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.13(\u0026minus;0.01, 2.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResearch type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(46117)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.89(1.46, 2.31)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.767,0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.851, 0.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCohort study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(11001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.07(0.88, 3.26)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.861,0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.624, 0.270\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKidney Transplantation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(173872)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.54(6.68, 10.40)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000,90.0%\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.881, 0.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGeographic location\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEurope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(48726)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.43(4.55, 8.31)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000,82.2%\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.348, 0.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(112587)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.50(4.33, 32.68)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000,97.1%\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.602, 0.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorth America\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(12559)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.57(\u0026minus;0.19,23.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.085,66.3%\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.317,-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eVery low\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResearch type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(120887)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.85(7.82,15.89)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000, 94.2%\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.573, 0.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCohort study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(52985)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.83(5.23, 8.43)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.008, 71.0%\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.624, 0.654\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeart Transplantation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(24102)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.37(2.02, 4.71)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.209, 30.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.748, 0.276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGeographic location\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEurope\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(5434)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.17(1.49, 6.85)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.119, 48.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.047\u003csup\u003e\u0026amp;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000, 0.798\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(18668)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.89(2.26, 3.53)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.834, 0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.317,-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResearch type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRetrospective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(19481)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.93(1.58, 6.28)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.237, 29.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000, 0.389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCohort study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(4621)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.93(\u0026minus;0.29, 6.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.091, 64.9%\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.317,-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLung Transplantation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(9351)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.61 (0.50, 2.71)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.649, 0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000, 0.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor SIR of RCC after kidney transplantation, significant different could be found in overall (8.54, 6.68 to 10.40), geographic location of Europe (6.43, 4.55 to 8.31) and Asia (18.50, 4.33 to 32.68) subgroups, retrospective study (11.85, 7.82 to 15.89) and cohort study (6.83, 5.23 to 8.43). Strangely, there was substantial heterogeneity within overall and all subgroups, and no source of heterogeneity was determined by meta-analysis. Therefore, sensitivity analysis was done for further analysis. From the outcome of sensitivity analysis, we found that the researches of Yeh CC(2020) and Engels EA(2011) may have a greater impact on the overall outcome (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003eA). Subsequently, significance could be found in overall after the adjustment also with substantial heterogeneity (7.15, 5.49 to 8.81; 0.000, 78.6%; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003eB), and geographic location of Europe (6.43, 4.55 to 8.31; 0.000, 82.2%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFor incident risk of RCC after heart transplantation, significance could be found in overall(3.37, 2.02 to 4.71), geographic location of Europe (4.17, 1.49 to 6.85) and Asia (2.89, 2.26 to 3.53) subgroups and retrospective study (3.93, 1.58 to 6.28), with low heterogeneity and low-moderate grade. Besides, meta-regression detected different geographic regions may influence the existence of heterogeneity(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.047). For the risk of RCC after lung transplantation, significant different with no heterogeneity could be found (1.61, 0.50 to 2.71).\u003c/p\u003e \u003cp\u003eIn summary, the incident of RCC risk could increased after solid organ transplantation, especially in the European subgroup.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis research followed standard PRISMA statement and registered with PROSPERO website. First, 16 original studies[\u003cspan additionalcitationids=\"CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] were yield through the layers processing, 11of them provided SIR and their 95% data of liver transplantation, 11 of them provide data of kidney transplantation, 6 of them in heart transplantation and 3 of them with data of lung transplantation(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Second, from pairwise meta-analysis, incident of RCC risk could increase from liver, kidney, heart and lung transplantation, and significance could find in most subgroups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Besides, meta-regression showed that grouping by geographic location maybe the source of heterogeneity. Third, sensitivity analysis determine that Yeh CC and Engels EA may had great influence on overall outcome of incident risk of RCC. After removing them, we could notice that SOT increase risk of RCC mainly in Europe group (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFrom our research, although the incidence rate of RCC will increase after SOT, we also found that the incidence rate RCC after kidney transplantation is higher (8.54, 6.68 to 10.40) than that of incidence rate such as liver, heart and lung transplantation. Moreover, we do not know what causes the clinical heterogeneity among adjustment forest. Kidney transplant recipients have at least a 2\u0026ndash;5 fold higher risk of developing or dying from malignant tumor than the general population. The increased risk of primary and recurrence cancer in transplant recipients is complex and attributed to oncogenic viruses, immunosuppression and altered T cell immunity[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The cause of heterogeneity may include different immunosuppressive agents, dose regimens, duration, etc. Immunosuppressant medication promotes impaired immunosurveillance, activation of oncogenic viruses, and have carcinogenic effects[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Different studies have described an increased risk of RCC development in patients with chronic kidney disease (CKD). As a results of the chronic uremic state in patients and other former risk factors associated with both CKD and malignancy[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Nowadays, risk factors for cancer-based on recipient characteristics known a pre-exist at the time of transplantation, such as sex differences that have not been well explored. And many medical disciplines have shown increasing awareness of how diseases manifest differently in men and women, trends in age-standardized cancer incidence rates differ by sex, being stable in men and increasing slightly among women during the most recent five years[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe mechanism of incident of RCC, immunosuppressive agents could induce carcinogenesis by reducing immunosurveillance and mechanisms involved in the immunologic control of oncogenic viral infection or direct deoxyribonucleic acid (DNA) damage. However, the therapeutic effect of each drug on RCC development remains controversial because of the use of multi-agent therapy regimens. The increased risk of RCC may be mediated by the overall or cumulative exposure to immunosuppression more than by the agent itself[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are also some limitations among our study. First, only 16 publications have been included into meta-analysis, and for the incident risk of RCC after heart and lung transplantation, only 6 and 3 articles have been included, the results from meta-analysis may not be accurate enough. Second, the subgroup analysis only grouped by geographic location (Europe, Asia, North America) and research type (retrospective study, cohort study). As for the incidence rate of RCC, the baseline difference in follow-up time is huge, and some original studies do not report the follow-up time, so it is difficult for us to conduct subgroup analysis. Third, we only did sensitivity analysis for renal transplantation which with higher heterogeneity. After sensitivity analysis, the heterogeneity among the studies was still large, which may be the impact of clinical heterogeneity of incidence RCC rate.\u003c/p\u003e \u003cp\u003eIn summary, the results of this systematic review and meta-analysis suggest that liver, kidney, heart and lung transplantation patients have an increased risk of processing RCC compared to the general population and most subgroups, especially in geographic location of European subgroup. Future patients-based retrospective and cohort study are required to explore the potential clinical risk factors associated with incident risk of RCC.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article and its supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWY, LYN, ZYS: Conceptualization. WY, LYN, GHF, SF, SHW: Data curation; Formal analysis; Methodology. LDS: Supervision. WY, LYN, ZYS: Writing - original draft. WY, LYN, GHF, SF, SHW, ZYS: Writing - review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublisher\u0026rsquo;s Note\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBlack CK, Termanini KM, Aguirre O, Hawksworth JS, Sosin M. Solid organ transplantation in the 21st century. 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Sex differences in cancer risk and outcomes after kidney transplantation. Transpl Rev (Orlando). 2021;35(3):100625. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.trre.2021.100625\u003c/span\u003e\u003cspan address=\"10.1016/j.trre.2021.100625\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Incidence of renal cell carcinoma, Solid organ transplantation, Malignant incidence, Systematic review, Meta-analysis ","lastPublishedDoi":"10.21203/rs.3.rs-2178376/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2178376/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The incidence rate of malignant tumors after solid organ transplantation is higher than the normal population. To identify the risk of renal cell carcinoma (RCC) after liver, kidney, heart and lung transplantation, respectively,\u0026nbsp;a combined meta-analysis has been conducted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThree databases were searched from inception until May 2022. Retrospective and cohort studies which focus on the statistical data of standardized incidence ratios (SIRs) of RCC after SOT more than one year have been included and extracted. The study was registered with PROSPERO, CRD4202022343633.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eSixteen original studies have been included for meta-analysis. Liver transplantation could increase the risk of RCC (SIR=0.73, 95%CI: 0.53 to 0.93) with no heterogeneity(\u003cem\u003eP\u003c/em\u003e=0.594, \u003cem\u003eI\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e=0.0%). And kidney transplantation could increase the risk of RCC(8.54, 6.68 to 10.40; 0.000,90.0%). Besides, heart and lung transplantation also could increase the risk of RCC(SIR=0.73, 95%CI: 0.53 to 0.93; SIR=1.61, 95%CI:0.50 to 2.71). Moreover, significance could also be found in most subgroups, especially the European group and retrospective study group. What’s more, after removing studies which have a greater impact on the overall outcome in RCC rate after kidney transplantation, heterogeneity did not solve and significant different was also observed in the European group (7.15, 5.49 to 8.81; 0.000, 78.6%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Liver, kidney, heart and lung transplantation patients have an increased risk of processing RCC compared to the general population and most subgroups, especially in geographic location of European subgroup.\u003c/p\u003e","manuscriptTitle":"Incidence of Renal Cell Carcinoma after Solid Organ Transplantation: a Systematic Review and Meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-01-03 15:25:55","doi":"10.21203/rs.3.rs-2178376/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-03-30T05:27:22+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-03-22T18:04:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-01-03T20:29:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54df767b-973d-4c7e-ae7a-599b5111b594","date":"2023-01-03T17:21:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"033193f4-8602-492e-bc36-b3699fd2e914","date":"2022-12-29T09:28:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-12-29T09:22:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-12-29T09:18:52+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-12-26T14:16:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-12-26T14:14:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2022-10-18T09:43:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"56c779f7-0322-4110-80a0-9c3e783c2b17","owner":[],"postedDate":"January 3rd, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-01-08T15:06:10+00:00","versionOfRecord":{"articleIdentity":"rs-2178376","link":"https://doi.org/10.1186/s12894-023-01389-1","journal":{"identity":"bmc-urology","isVorOnly":false,"title":"BMC Urology"},"publishedOn":"2024-01-06 15:01:19","publishedOnDateReadable":"January 6th, 2024"},"versionCreatedAt":"2023-01-03 15:25:55","video":"","vorDoi":"10.1186/s12894-023-01389-1","vorDoiUrl":"https://doi.org/10.1186/s12894-023-01389-1","workflowStages":[]},"version":"v1","identity":"rs-2178376","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2178376","identity":"rs-2178376","version":["v1"]},"buildId":"ehx78VzkSd0WSzXnipQa-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}