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Françot M, Mesnard B, Kerleau C, Chelghaf I, de Vergie S, Perrouin Verbe MA, Rigaud J, Karam G, Supiot S, Rio E, Blancho G, Giral M, Branchereau J. Kidney transplantation after pelvic radiotherapy: Increased morbidity? THE FRENCH JOURNAL OF UROLOGY 2024; 34:102667. [PMID: 38849036 DOI: 10.1016/j.fjurol.2024.102667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION The impact of pelvic irradiation on kidney transplant surgery is still unclear. The main objective of our study is to evaluate the feasibility and the safety of renal transplantation following pelvic radiotherapy. METHODS We collected characteristics and kidney transplant data from patients with a history of pelvic cancer treated with pelvic irradiation between 2005 and 2021. These data were collected via the prospective information system "Computerized Data Validated in Transplantation" (DIVAT) and medical records. We carried out a comparative study with a non-irradiated matched control group to compare the data of intraoperative surgeries, complications reported postoperatively as well as survival of the graft and the patient. Patients were matched on age, sex, side of graft implantation, and graft rank. RESULTS Twenty-four patients were collected with an average age of 65, 18 patients were treated for prostatic adenocarcinoma, 4 for gynecological cancer and 2 testicular cancers. Twenty-one patients were treated by radiotherapy, 3 by brachytherapy. Eight patients had a target dose on the iliac lymph nodes. The comparative study showed a significant difference in operative difficulty (n=15 versus n=1, P<0.01), operative duration (190min versus 149min, P=0.005), occurrence of lymphocele (P=0.041). Urinary anastomosis surgical techniques were different, 83.3% of control patients had an uretero-vesical anastomosis against 58.3% of patients with a history of irradiation (P=0.057) and about 29% of irradiated patients had an uretero-ureteral anastomosis. There was no other significant difference in per and postoperative criteria or survival. DISCUSSION A history of pelvic irradiation significantly increases the technical complexity of kidney transplantation without impacting safety and kidney graft survival. A history of pelvic irradiation should not be a contraindication to kidney transplant. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Marc Françot
- Department of Urology, Nantes University Hospital, Nantes, France.
| | - Benoit Mesnard
- Department of Urology, Nantes University Hospital, Nantes, France
| | - Clarisse Kerleau
- Center for Research in Transplantation and Translational Immunology, Nantes University Hospital, Nantes, France
| | - Ismael Chelghaf
- Department of Urology, Nantes University Hospital, Nantes, France
| | | | | | - Jérome Rigaud
- Department of Urology, Nantes University Hospital, Nantes, France
| | - Georges Karam
- Department of Urology, Nantes University Hospital, Nantes, France
| | - Stéphane Supiot
- Department of Radiotherapy, West Cancer Institute, Nantes University Hospital, Saint-Herblain, France
| | - Emmanuel Rio
- Department of Radiotherapy, West Cancer Institute, Nantes University Hospital, Saint-Herblain, France
| | - Gilles Blancho
- Department of Nephrology and Immunology, Nantes University Hospital, Nantes, France
| | - Magali Giral
- Department of Nephrology and Immunology, Nantes University Hospital, Nantes, France
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Rumpff C, Lieb V, Wullich B, Schiffer M, Kunath F, Apel H. Kidney transplantation in prostate cancer patients after local therapy with curative intent: a systematic review. World J Urol 2024; 42:127. [PMID: 38460021 DOI: 10.1007/s00345-024-04817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/16/2024] [Indexed: 03/11/2024] Open
Abstract
PURPOSE It is still unclear whether kidney transplantation can be safely performed in patients with prostate cancer after local therapy with curative intent. METHODS The protocol was registered in PROSPERO. We systematically searched Google, MEDLINE, the Cochrane Library, and the ICTRP for studies, official standards, clinical practice guidelines and organ transplant laws. Two review authors independently examined the full-text reports and identified relevant studies and one review author extracted the data. We assessed the overall certainty of the evidence for each outcome according to the GRADE approach. RESULTS We identified 1346 references through electronic database searching and finally included 6 references for official standards, clinical practice guidelines, and organ transplant laws, and 6 references for retrospective studies with very low certainty of evidence. We identified no prospective or ongoing studies and reported all results narratively. CONCLUSION We recommend that decisions on kidney transplantation in patients with prostate cancer after local therapy with curative intent should be made on a case-by-case basis. It is indispensable to consult with health care professionals or specialists at transplant centers to obtain individualized information regarding the waiting time requirements for renal transplantation in prostate cancer patients after local therapy with curative intent. No recommendation can be made regarding the waiting times after prostate cancer therapy with curative intent.
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Affiliation(s)
- C Rumpff
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - V Lieb
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - B Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - M Schiffer
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - F Kunath
- Klinik für Urologie und Kinderurologie, Klinikum Bayreuth GmbH, Bayreuth, Germany
- Medizinische Fakultät am Medizincampus Oberfranken, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - H Apel
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
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Poinard F, Bessede T, Barrou B, Drouin S, Karam G, Branchereau J, Alezra E, Thuret R, Verhoest G, Goujon A, Millet C, Boissier R, Delaporte V, Sallusto F, Prudhomme T, Boutin JM, Culty T, Timsit MO. Impact of newly diagnosed prostate cancer at time of evaluation for renal transplantation. Clin Transplant 2023; 37:e14998. [PMID: 37138463 DOI: 10.1111/ctr.14998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 05/05/2023]
Abstract
Systematic screening for prostate cancer is widely recommended in candidates for renal transplant at the time of listing. There are concerns that overdiagnosis of low-risk prostate cancer may result in reducing access to transplant without demonstrated oncological benefits. The objective of the study was to assess the outcome of newly diagnosed prostate cancer in candidates for transplant at the time of listing, and its impact on transplant access and transplant outcomes according to treatment options. This retrospective study was conducted over 10 years in 12 French transplant centers. Patients included were candidates for renal transplant at the time of prostate cancer diagnosis. Demographical and clinical data regarding renal disease, prostate cancer, and transplant surgery were collected. The primary outcome of the study was the interval between prostate cancer diagnosis and active listing according to treatment options. Overall median time from prostate cancer diagnosis to active listing was 25.0 months [16.4-40.2], with statistically significant differences in median time between the radiotherapy and the active surveillance groups (p = .03). Prostate cancer treatment modalities had limited impact on access and outcome of renal transplantation. Active surveillance in low-risk patients does not seem to compromise access to renal transplantation, nor does it impact oncological outcomes.
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Affiliation(s)
- Florence Poinard
- Department of Urology and Renal Transplantation, Georges Pompidou European Hospital, Paris, France
| | - Thomas Bessede
- Urology Department, Hopitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, France
| | - Benoit Barrou
- Department of Urology and Renal Transplantation, APHP - Sorbonne University, Pitié Salpêtrière University Hospital, Paris, France
| | - Sarah Drouin
- Department of Urology and Renal Transplantation, APHP - Sorbonne University, Pitié Salpêtrière University Hospital, Paris, France
| | - Georges Karam
- Department of Urology & Renal Transplantation, Hotel Dieu University Hospital, Nantes, France
| | - Julien Branchereau
- Department of Urology & Renal Transplantation, Hotel Dieu University Hospital, Nantes, France
| | - Eric Alezra
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Rodolphe Thuret
- Department of Urology and Transplantation, Montpellier University Hospital, Montpellier, France
| | - Gregory Verhoest
- Department of Urology and Transplantation, Rennes University Hospital, Rennes, France
| | - Anna Goujon
- Department of Urology and Transplantation, Rennes University Hospital, Rennes, France
| | - Clementine Millet
- Department of Urology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | - Romain Boissier
- Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique Marseille, Aix-Marseille University, Marseille, France
| | - Veronique Delaporte
- Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique Marseille, Aix-Marseille University, Marseille, France
| | - Federico Sallusto
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | | | - Thibaut Culty
- Department of Urology, Angers University Hospital, Angers, France
| | - Marc-Olivier Timsit
- Department of Urology and Renal Transplantation, Georges Pompidou European Hospital, Paris, France
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