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Okumi M, Inoue Y, Miyashita M, Ueda T, Fujihara A, Hongo F, Ukimua O. Genitourinary malignancies in kidney transplant recipients. Int J Urol 2024. [PMID: 39316503 DOI: 10.1111/iju.15588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/09/2024] [Indexed: 09/26/2024]
Abstract
Advances in immunosuppressive therapy and postoperative management have greatly improved the graft and patient survival rates after kidney transplantation; however, the incidence of post-transplant malignant tumors is increasing. Post-renal transplantation malignant tumors are associated with renal failure, immunosuppression, and viral infections. Moreover, the risk of developing cancer is higher in kidney transplant recipients than in the general population, and the tendency to develop cancer is affected by the background and environment of each patient. Recently, cancer after kidney transplantation has become the leading cause of death in Japan. Owing to the aggressive nature and poor prognosis of genitourinary malignancies, it is crucial to understand their epidemiology, risk factors, and best practices in kidney transplant recipients. This review has a special emphasis on the epidemiology, risk factors, and treatment protocols of genitourinary malignancies in kidney transplant recipients to enhance our understanding of the appropriate management strategies. Optimal immunosuppressive therapy and cancer management for these patients remain controversial, but adherence to the general guidelines is recommended.
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Affiliation(s)
- Masayoshi Okumi
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuta Inoue
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masatsugu Miyashita
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Ueda
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Atsuko Fujihara
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumiya Hongo
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Ukimua
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Miyazaki Y, Yoshiya K, Nishihara G, Takeshita M, Yasunaga C. Development of Bilateral Renal Cell Carcinoma in the Birt-Hogg-Dubé Syndrome Before and After Living-Related Kidney Transplantation. Transplant Direct 2023; 9:e1502. [PMID: 37313315 PMCID: PMC10259644 DOI: 10.1097/txd.0000000000001502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 06/15/2023] Open
Affiliation(s)
- Yuko Miyazaki
- The Kidney Center, Saiseikai Yahata Hospital, Kitakyushu, Japan
| | - Keiji Yoshiya
- The Kidney Center, Saiseikai Yahata Hospital, Kitakyushu, Japan
| | | | - Morishige Takeshita
- The Department of Pathology and Laboratory Medicine, Saiseikai Yahata Hospital, Kitakyushu, Japan
| | - Chikao Yasunaga
- The Kidney Center, Saiseikai Yahata Hospital, Kitakyushu, Japan
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Wang L, Zhang YN, Chen GY. Bladder paraganglioma after kidney transplantation: A case report. World J Clin Cases 2022; 10:9044-9049. [PMID: 36157666 PMCID: PMC9477062 DOI: 10.12998/wjcc.v10.i25.9044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/25/2022] [Accepted: 07/29/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Kidney transplantation is associated with an increased risk of tumors in the urinary bladder. Among all the pathological types of tumors in the bladder, paraganglioma, which arises from extra-adrenal paraganglia and consists of chromaffin cells, is rare. Paragangliomas might cause severe clinical symptoms due to catecholamine hypersecretion or mass compression. Bladder paragangliomas are rare, especially those appearing after kidney transplantation. Here, we report a case of bladder paraganglioma developing after kidney transplantation.
CASE SUMMARY A 63-year-old woman received a kidney transplant 12 years ago and took oral immunosuppressants (cyclosporine, mizoribine, and methylprednisolone) for regular post-transplant treatment. The patient felt no discomfort and she came to the hospital for a routine checkup. A mass located in the bladder was incidentally discovered by computed tomography, and she underwent surgical treatment. A 2 cm × 2 cm invasive mass was found in the trigone of the bladder and the mass was removed. The diagnosis of paraganglioma was confirmed by morphology and immunophenotyping. The patient had a good prognosis and is still alive.
CONCLUSION Paraganglioma can grow in the bladder, which might cause no clinical symptoms. The diagnosis mainly depends on morphology and immunophenotyping. Surgical resection is an important treatment option for such patients.
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Affiliation(s)
- Lin Wang
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yan-Ning Zhang
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Guang-Yong Chen
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Piana A, Andras I, Diana P, Verri P, Gallioli A, Campi R, Prudhomme T, Hevia V, Boissier R, Breda A, Territo A. Small renal masses in kidney transplantation: overview of clinical impact and management in donors and recipients. Asian J Urol 2022; 9:208-214. [PMID: 36035353 PMCID: PMC9399547 DOI: 10.1016/j.ajur.2022.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/24/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022] Open
Abstract
Kidney transplantation is the best replacement treatment for the end-stage renal disease. Currently, the imbalance between the number of patients on a transplant list and the number of organs available constitutes the crucial limitation of this approach. To expand the pool of organs amenable for transplantation, kidneys coming from older patients have been employed; however, the combination of these organs in conjunction with the chronic use of immunosuppressive therapy increases the risk of incidence of graft small renal tumors. This narrative review aims to provide the state of the art on the clinical impact and management of incidentally diagnosed small renal tumors in either donors or recipients. According to the most updated evidence, the use of grafts with a small renal mass, after bench table tumor excision, may be considered a safe option for high-risk patients in hemodialysis. On the other hand, an early small renal mass finding on periodic ultrasound-evaluation in the graft should allow to perform a conservative treatment in order to preserve renal function. Finally, in case of a renal tumor in native kidney, a radical nephrectomy is usually recommended.
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Urological Cancers and Kidney Transplantation: a Literature Review. Curr Urol Rep 2021; 22:62. [PMID: 34913107 DOI: 10.1007/s11934-021-01078-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide an overview of epidemiology, risk factors, and treatment of urological malignancies in renal transplant recipients (RTR). RECENT FINDINGS Although optimal immunosuppressive therapy and cancer management in these patients remain controversial, adherence to general guidelines is recommended. Kidney transplantation is recognized as the standard of care for the treatment of end-stage renal disease (ESRD) as it offers prolonged survival and better quality of life. In the last decades, survival of RTRs has increased as a result of improved immunosuppressive therapy; nonetheless, the risk of developing cancer is higher among RTRs compared to the general population. Urological malignancies are the second most common after hematological cancer and often have more aggressive behavior and poor prognosis.
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Ramachandran R, Bharati J, Gupta P, Gorsi U, Mavuduru R, Kumar V, Rathi M, Kohli H. Immunosuppression after the diagnosis of renal allograft renal cell carcinoma in two transplant recipients: Case reports and review of the literature. INDIAN JOURNAL OF TRANSPLANTATION 2021. [DOI: 10.4103/ijot.ijot_70_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hanna B, White J, Chalasani V, McGinn S, Winter M. Double partial nephrectomy in allograft transplanted kidney. Urol Case Rep 2020; 35:101517. [PMID: 33318944 PMCID: PMC7725738 DOI: 10.1016/j.eucr.2020.101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/30/2020] [Indexed: 11/21/2022] Open
Abstract
A 61-year-old female presented with an incidental anterior mid pole renal mass on ultrasound. She had previously undergone live directed donor renal transplantation 13 years prior. As the 10 year survival of living transplant recipients increases, malignancy presentations will continue to rise. Nephron sparing surgery in renal allografts is sparse due to difficult operative dissection and complicated hila vascular control. We present the use of manual atraumatic graded bowel clamp pressure around the resected tumour as a viable option to safely perform partial nephrectomy in a transplanted kidney.
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Affiliation(s)
- Bishoy Hanna
- Nepean Urology Research Group, Nepean Hospital, Derby St, Kingswood, NSW 2747, Australia
| | - Jared White
- Department of Urology, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW 2065, Australia
| | - Venu Chalasani
- Department of Urology, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW 2065, Australia.,Department of Urology, University of Sydney, Camperdown, NSW 2006, Australia.,Department of Urology, Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia
| | - Stella McGinn
- Department of Nephrology, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW 2065, Australia
| | - Matthew Winter
- Nepean Urology Research Group, Nepean Hospital, Derby St, Kingswood, NSW 2747, Australia.,Department of Urology, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW 2065, Australia
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Kluch M, Kurnatowska I, Matera K, Łokieć K, Puzio T, Czkwianianc E, Grzelak P. Nutrition Trends in Patients Over the Long Term After Kidney Transplantation. Transplant Proc 2020; 52:2357-2362. [PMID: 32571697 DOI: 10.1016/j.transproceed.2019.12.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/06/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Nutritional behaviors may exert important influence on morbidity and graft function in patients after kidney transplantation (KT). Nutritional status is closely related to potential risk factors of developing posttransplant complications, including diabetes mellitus, weight gain, and negative effects on immunosuppressive therapy. The aim of this study was to assess the dietary intake in patients after KT. DESIGN AND METHODS Nutritional intake of 154 (61 women and 93 men) patients was assessed based on a questionnaire regarding food intake (proteins, fats, carbohydrates, cholesterol, sugar, phosphorus, calorific value) within 3 working days preceding the routine outpatient posttransplant visit. Patient medical history, concomitant medications, and estimated glomerular filtration rate (eGFR) was obtained from medical charts. RESULTS The mean age (years) ± SD of patients was 51.9 ± 14.1. The patients were evaluated 94 ± 67 months after KT, with a median eGFR of 53 (range, 41.2-64.1) mL/min/1.73 m2. Sixty-two percent of patients had increased body mass index values. The mean total energy intake was 2159.4 ± 551.9 kcal/day. The patients reported elevated salt (8.5 ± 2.4 g per day) and fat intake (99.4 ± 3.2 g per day) including 57% saturated fatty acids. The patients consumed products containing high amounts of sugars (108.2 ± 107.0 g per day), carbohydrates (238.3 ± 64.3 g per day), and cholesterol (303.6 ± 11.1 mg per day). The diet among kidney recipients consisted predominantly of fats, meat, cured meat, and sweets. CONCLUSIONS The nutritional behaviors of patients after KT are in most cases poor. Improvement of eating habits in these patients seems to be a simple method to preserve kidney function over the long term.
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Affiliation(s)
- Małgorzata Kluch
- Department of Gastroenterology, Allergology and Paediatrics, Polish Mother's Memorial Hospital - Research Institute, Łódź, Poland
| | - Ilona Kurnatowska
- Department of Internal Medicine and Transplant Nephrology Medical University of Lodz, Łódź, Poland
| | - Katarzyna Matera
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland.
| | - Katarzyna Łokieć
- Department of Propaedeutic of Civilization Diseases, Central Clinical Hospital of the Medical University of Lodz, Łódź, Poland
| | - Tomasz Puzio
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Elżbieta Czkwianianc
- Department of Gastroenterology, Allergology and Paediatrics, Polish Mother's Memorial Hospital - Research Institute, Łódź, Poland
| | - Piotr Grzelak
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
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Vaudreuil L, Bessede T, Boissier R, Bouye S, Branchereau J, Caillet K, Kleinclauss F, Verhoest G, Tillou X. De novo renal carcinoma arising in non-functional kidney graft: a national retrospective study. Int Urol Nephrol 2020; 52:1235-1241. [PMID: 32107673 DOI: 10.1007/s11255-020-02422-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/18/2020] [Indexed: 01/20/2023]
Abstract
AIM Characteristics of renal carcinoma arising in non-functional graft in renal transplant recipients (RTR) are unknown. We studied a large national retrospective cohort to analyze circumstances of diagnosis, treatment and outcome compared to the literature. METHODS Study included all RTR presenting with kidney graft tumors irrespective of the histology, except those with lymphoma and including those tumors arising in non-functional renal graft. Between January 1988 and December 2018, 56,806 patients had renal transplantation in the 32 centers participating in this study. Among this cohort, 18 renal graft tumors were diagnosed in non-functional grafts. RESULTS The median patient age at the time of diagnosis was 42.1 years (31.7-51.3). Median age of kidney grafts at the time of diagnosis was 56.4 (23.2-63.4). Eight (44.4%) tumors were discovered fortuitously on renal graft histologic analysis. Fourteen tumors (77.8%) were papillary carcinomas. Two patients had clear cell carcinomas and one patient had a pTa high-grade multifocal urothelial carcinoma in the graft of the upper tract with an in situ carcinoma. CONCLUSION Renal carcinomas in non-functional grafts are rare entities and most of them are diagnosed fortuitously. Despite the fact that these tumors are small, low grade and with a good prognosis, regular monitoring of non-functional grafts should be performed with at least an annual ultrasonography.
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Affiliation(s)
- Lionel Vaudreuil
- Department of Urology and Renal Transplantation, CHU de Caen, Urology and Transplantation, Avenue de La Côte de Nacre, 14000, Caen, France
| | - Thomas Bessede
- Hôpital Kremlin-Bicêtre, Urology and Transplantation, Paris, France
| | - Romain Boissier
- Hôpital de La Conception, Urology and Transplantation, Marseille, France
| | | | | | - Kevin Caillet
- CHU d'Amiens, Urology and Transplantation, Amiens, France
| | | | | | - Xavier Tillou
- Department of Urology and Renal Transplantation, CHU de Caen, Urology and Transplantation, Avenue de La Côte de Nacre, 14000, Caen, France.
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Eggers H, Güler F, Ehlers U, Ivanyi P, Peters I, Grünwald V. Renal cell carcinoma in kidney transplant recipients: descriptive analysis and overview of a major German transplant center. Future Oncol 2019; 15:3739-3750. [PMID: 31664864 DOI: 10.2217/fon-2019-0397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: Elevated risk of malignancy-related death after renal transplantation is reported and renal malignancy was ranked as the third most frequent site of malignancy-related death. However, there is a lack of data characterizing renal cell carcinoma associated with end-stage renal disease and kidney transplantation. Patients & methods: We retrospectively identified 5250 patients who underwent kidney transplantation at the Hannover Medical School since 1970. Results: 124 patients with renal cell carcinoma (incidence 2.36%) were identified. Among all patients, metastatic recurrence was noted in 4.8%. In multivariate analysis, tumor stage and hemoglobin were identified as independent prognostic markers of OS, while tumor grading was predictive for disease recurrence. Conclusion: Apart from showing the prognostic value of tumor staging and hemoglobin, our data suggest that a risk adapted approach for early transplantation is feasible.
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Affiliation(s)
- Hendrik Eggers
- Department of Hematology, Hemostasis, Oncology & Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Faikah Güler
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Ulrike Ehlers
- Department of Hematology, Hemostasis, Oncology & Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Philipp Ivanyi
- Department of Hematology, Hemostasis, Oncology & Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Inga Peters
- Department of Urology & Urologic Oncology, Hannover Medical School, Hannover, Germany
| | - Viktor Grünwald
- Department of Hematology, Hemostasis, Oncology & Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.,Interdisciplinary Genitourinary Oncology at the West-German Cancer Center, Clinic for Internal Medicine (Tumor Research) & Clinic for Urology, Essen University Hospital, Essen, Germany
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