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Lee HJ, Lim EJ, Woo SJQ, Aslim EJ, Ng LG, Gan VHL. De Novo Urological Malignancies After Renal Transplantation: An Asian 30-Year Experience. Clin Transplant 2024; 38:e15415. [PMID: 39049619 DOI: 10.1111/ctr.15415] [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: 05/02/2024] [Revised: 06/19/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND As the incidence of urological malignancies after renal transplantation (RT) is observed to be greater than in the general population, a better understanding of them is important. We present our experience with urological tumors in RT recipients at our transplant center, and analyze their incidence, management and outcomes. MATERIALS AND METHODS A retrospective analysis of 2177 RT recipients on follow-up at our center between 1990 and 2022 was conducted for de novo genitourinary malignancy. Patients diagnosed with malignancy before transplantation were excluded. Clinicopathological data at diagnosis and follow-up were collected and analyzed. Kaplan-Meier estimates were used to evaluate overall survival (OS) and cancer-specific survival (CSS). Statistical analysis was performed using IBM SPSS v.24 (IBM Corp., Armonk, NY, USA). RESULTS The overall incidence of Urological malignancies was 3.9%, with 89 cancers diagnosed in 85 patients. Renal cell carcinoma was most common (n = 61, 68.5%), followed by prostate cancer (n = 10, 11.2%), urothelial carcinoma (n = 10, 11.2%), squamous cell carcinoma of the penis/scrotum (n = 7, 7.9%), and testicular cancer (n = 1, 1.1%). Mean duration between transplantation and diagnosis of malignancy was 9.9 (0.4-20.7) years. At a median follow-up of 4.6 (018.2) years, 27 deaths were seen; 7(25.9%) were due to urological malignancy. CSS rates were 86% and 78% at five and ten years, respectively, after diagnosis. CONCLUSION We present one of the largest series of de novo urological malignancies observed over an extended 30-year follow-up of RT recipients, demonstrating an elevated risk in line with other studies. Regular surveillance for malignancies is advised, in order to ensure early diagnosis and management.
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Affiliation(s)
- Han Jie Lee
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | | | - Edwin J Aslim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Lay Guat Ng
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Valerie Huei Li Gan
- Department of Urology, Singapore General Hospital, Singapore, Singapore
- Singhealth Duke-NUS Transplant Centre, Singapore, Singapore
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Messing EM. BCG in Immunocompromised Patients: Is it effective? Is it safe? Bladder Cancer 2024; 10:89-91. [PMID: 38993531 PMCID: PMC11181704 DOI: 10.3233/blc-249001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 07/13/2024]
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Durant AM, Choudry MM, Madura G, Mi L, Faraj KS, Tyson MD. Bacillus Calmette-Guerin (BCG) therapy is safe and effective in non-muscle invasive bladder cancer (NMIBC) patients with immunomodulating conditions. Urol Oncol 2024; 42:21.e21-21.e28. [PMID: 37852817 PMCID: PMC10842448 DOI: 10.1016/j.urolonc.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/18/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Bacillus Calmette-Guerin (BCG) is the most effective therapy available to treat high-risk nonmuscle invasive bladder cancer (NMIBC) patients. However, for patients with immunomodulating conditions BCG is a relative contraindication due to efficacy and safety concerns. To our knowledge, no population-level study evaluating the efficacy and safety profile of BCG for immunomodulated patients exists. METHODS NMIBC patients aged 66 years or older were identified in the Surveillance, Epidemiology, and End Results (SEER) - Medicare database from 1975-2013. All patients completed adequate BCG (at least 5 plus 2 treatments completed within 12 months of diagnosis). Two groups were defined: an immunomodulated population identified by immunomodulating conditions such as solid-organ transplantation, HIV, and autoimmune conditions, and an immunocompetent group. The primary endpoint was 5-year progression-free survival defined as progression to systemic chemotherapy, checkpoint inhibitors, radical or partial cystectomy, metastasis, or cancer-specific death. A safety analysis was performed as a secondary outcome. RESULTS In a total of 4,277 patients with NMIBC who completed adequate BCG, 606 (14.2%) were immunomodulated. The immunomodulated group was older at diagnosis (P < 0.001), more likely to be female (P < 0.001), more likely to live in a metropolitan area (P < 0.001), and had higher Charlson comorbidity scores (P < 0.001). There were no differences in progression to chemotherapy (P = 0.17), checkpoint inhibitors (P > 0.99), radical cystectomy (P = 0.40), partial cystectomy (P = 0.93), metastasis (P = 0.19), cancer-specific death (P = 0.18) or 5-year total bladder cancer progression (P = 0.30) between the groups. For the safety analysis, rates of disseminated BCG were similar between immunomodulated and immunocompetent patients (0.7% vs. <1.8%, P = 0.51). On multivariable analysis 5-year total bladder cancer progression (HR 1.07 [CI 0.88-1.30]) was similar between the groups. CONCLUSION Rates of bladder cancer progression and disseminated BCG complications 5-years after BCG therapy were similar regardless of immunomodulation status. These findings suggest that BCG intravesical therapy can be offered to immunomodulated patients with high-risk NMIBC although theoretical infectious complication risks remain.
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Affiliation(s)
- Adri M Durant
- Department of Urology, Mayo Clinic Arizona, Phoenix, AZ.
| | | | - Grace Madura
- Mayo Clinic College of Medicine and Science, Scottsdale, AZ
| | - Lanyu Mi
- Department of Quantitative Health Sciences, Mayo Clinic Arizona, Scottsdale, AZ
| | - Kassem S Faraj
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Mark D Tyson
- Department of Urology, Mayo Clinic Arizona, Phoenix, AZ
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Cleveland B, Gardeck A, Holten M, Jiang S, Jackson S, Pruett T, Warlick C. Characteristics and Outcomes of De Novo Genitourinary Malignancy in Solid Organ Transplant Recipients at the University of Minnesota. Transplant Proc 2023; 55:2027-2034. [PMID: 37775402 DOI: 10.1016/j.transproceed.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/30/2023] [Accepted: 07/21/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Studies examining outcomes of genitourinary malignancy (GU) in the solid organ transplant (SOT) population predominantly focus on renal transplant recipients and consist of relatively small cohorts. We aimed to expand knowledge of the characteristics and outcomes of de novo GU malignancies in all patients with SOT at a large tertiary center. METHODS The SOT database was queried for recipients with de novo bladder, renal cell, and prostate malignancy, and a retrospective chart review was performed. Descriptive statistics and Kaplan-Meier survival estimates were calculated. Cox proportional hazards regression was used for multivariate modeling of predictive factors in the development of GU malignancy. RESULTS Solid organ transplant recipients with de novo bladder malignancy comprised 64.3% with high grade and 38.1% with advanced stage (≥T2) disease at initial diagnosis. Only 3.7% of patients with de novo renal cell carcinoma presented with metastatic disease, and 13.6% with localized disease developed recurrences. The most common stage in de novo prostate cancer patients was pT3 (52.2%). Kaplan-Meier estimates (95% CI) for 5-year overall (OS) and cancer-specific survival (CSS) were 44.12% (31.13-62.52) and 80.80% (68.85-94.81) for bladder, 78.90% (68.93-90.30) and 96.61% (92.10-100.00) for renal cell, and 81.18% (72.01-91.51) and 96.16% (90.95-100.00) for prostate cancer, respectively. Age at transplant and time from transplant to cancer diagnosis were predictive of de novo bladder cancer OS (P = .042 and .021, respectively). CONCLUSION To our knowledge, this is the largest single-center cohort examined for GU malignancy after SOT. Bladder and renal cell cancer had worse OS but similar CSS as historical rates for nontransplant patients. De novo prostate cancer had similar CSS.
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Affiliation(s)
- Brent Cleveland
- Department of Urology, University of Minnesota, Minneapolis, Minnesota; Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.
| | - Andrew Gardeck
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Matthew Holten
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Song Jiang
- Department of Urology, University of Minnesota, Minneapolis, Minnesota; Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Scott Jackson
- Complex Care Analytics, MHealth Fairview, Minneapolis, Minnesota
| | - Timothy Pruett
- Department of Surgery, Division of Transplantation, University of Minnesota, Minneapolis, Minnesota
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Crocerossa F, Autorino R, Derweesh I, Carbonara U, Cantiello F, Damiano R, Rubio-Briones J, Roupret M, Breda A, Volpe A, Mir MC. Management of renal cell carcinoma in transplant kidney: a systematic review and meta-analysis. Minerva Urol Nephrol 2023; 75:1-16. [PMID: 36094386 DOI: 10.23736/s2724-6051.22.04881-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION After transplantation, approximately 10% of renal cell carcinomas are detected in graft kidneys. These tumors (gRCC) present surgeons with the difficulty of finding a treatment that guarantees both oncological clearance and maintenance of function. We conducted a systematic review and an individual patient data meta-analysis on the oncology, safety and functional outcomes of the available treatments for gRCC. EVIDENCE ACQUISITION A systematic search was performed across MEDLINE, EMBASE, and Web of Science including any study reporting perioperative, functional and survival outcomes for patients undergoing graft nephrectomy (GN), partial nephrectomy (PN) or thermal ablation (TA) for gRCC. Quade's ANCOVA, Spearman Rho and Pearson χ2, Kaplan-Meier, Log-rank and Standard Cox regression and other tests were used to compare treatments. Studies' quality was evaluated using a modified version of Newcastle Ottawa Scale. EVIDENCE SYNTHESIS A number of 29 studies (357 patients) were included. No differences between TA and PN were found in terms of safety, functional and oncological outcomes for T1a gRCCs. When applied to pT1b gRCC, PN showed no difference in complications, progression or cancer-specific deaths compared to smaller lesions; PN validity for pT2 gRCCs should be considered unverified due to lack of sufficient evidence. The efficacy and safety of PN or TA for multiple gRCC remain controversial. In case of non-functioning, large (T≥2), complicated or metastatic gRCCs, GN appears to be the most reasonable choice. Quality of evidence ranged from very low to moderate. Studies with large cohorts and longer follow-up are still needed to clarify oncological and functional differences. CONCLUSIONS PN and TA might be offered as a nephron-sparing treatment in patients with T1a gRCC. There is no significant difference between these options and GN in terms of oncological outcomes and complications. PN and TA offer similar functional outcomes and graft preservation. PN for T1b gRCC seems feasible and safe, but its validity should be considered unverified.
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Affiliation(s)
- Fabio Crocerossa
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA.,Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | | | - Umberto Carbonara
- Division of Urology, Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA.,Unit of Andrology and Kidney Transplantation, Department of Urology, University of Bari, Bari, Italy
| | - Francesco Cantiello
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Jose Rubio-Briones
- Department of Urology, Instituto Valenciano Oncologia (IVO) Foundation, Valencia, Spain
| | - Morgan Roupret
- Department of Urology, GRC5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Alberto Breda
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Alessandro Volpe
- Division of Urology, Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - M Carmen Mir
- Urology Department, IMED Hospitals, Valencia, Spain -
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Systematic review on oncologic outcomes on adjuvant endovesical treatment for non-muscle invasive bladder cancer in patients with solid organ transplant. World J Urol 2022; 40:2901-2910. [PMID: 36367586 DOI: 10.1007/s00345-022-04188-9] [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: 04/10/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Urothelial carcinoma has a higher incidence in renal transplanted patients according to several registries (relative risk × 3), and the global prognosis is inferior to the general population. The potential impact of immunosuppressive therapy on the feasibility, efficacy, and complications of endovesical treatment, especially Bacillus Calmette-Guerin, has a low level of evidence. We performed a systematic review that aimed to assess the morbidity and oncological outcomes of adjuvant endovesical treatment in solid organ transplanted patients. METHODS Medline was searched up to December 2021 for all relevant publications reporting oncologic outcomes of endovesical treatment in solid organ transplanted patients with NMIBC. Data were synthesized in light of methodological and clinical heterogeneity. RESULTS Twenty-three retrospective studies enrolling 238 patients were included: 206 (96%) kidney transplants, 5 (2%) liver transplants, and 2 (1%) heart transplants. Concerning staging: 25% were pTa, 62% were pT1, and 22% were CIS. 140/238 (59%) patients did not receive adjuvant treatment, 50/238 (21%) received mitomycin C, 4/238 (2%) received epirubicin, and 46/238 (19%) received BCG. Disease-free survival reached 35% with TURBT only vs. 47% with endovesical treatment (Chi-square test p = 0.08 OR 1.2 [0.98-1.53]). The complication rate of endovesical treatment was 12% and was all minor (Clavien-Dindo I). CONCLUSION In solid organ transplanted patients under immunosuppressive treatment, both endovesical chemotherapy and BCG are safe, but the level of evidence concerning efficacy in comparison with the general population is low. According to these results, adjuvant treatment should be proposed for NMIC in transplanted patients as in the general population.
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Lancellotta V, D'Aviero A, Fionda B, Casà C, Esposito I, Preziosi F, Acampora A, Marazzi F, Kovács G, Jereczek-Fossa BA, Morganti AG, Valentini V, Gambacorta MA, Romagnoli J, Tagliaferri L. Immunosuppressive treatment and radiotherapy in kidney transplant patients: A systematic review. World J Radiol 2022; 14:60-69. [PMID: 35432777 PMCID: PMC8966497 DOI: 10.4329/wjr.v14.i3.60] [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: 10/11/2021] [Revised: 12/20/2021] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Immunosuppression (IS) therapy may contribute to cancer development. Some authors have proposed to reduce immunosuppression drugs dose in case of viral infections, in immunosuppression-related diseases, and in patients undergoing radiotherapy. The present analysis reports the results of a systematic review on kidney transplant recipients undergoing immunosuppression and radiotherapy.
AIM To define if it is necessary reduce immunosuppression drugs during radiotherapy.
METHODS The literature search was based on three electronic databases (Pubmed, Scopus, and Web of Science) using selected keywords linked through the "AND" and "OR" Boolean operators to build specific strings for each electronic search engine. Two researchers independently screened the citations, and disagreement was resolved by discussion or through the intervention of a third author. The review was conducted and reported according to the PRISMA statement. Extracted data were narratively synthesized, and, where possible, frequencies, percentages, and ranges were calculated.
RESULTS The literature search resulted in 147 citations. After abstracts screening, 21 records were selected for full-text evaluation. Fifteen of these were excluded, leaving six papers considered suitable for analysis. There is still no clear evidence that withdrawing antimetabolites and/or calcineurin inhibitors and/or mammalian target of rapamycin-inhibitors, as opposed to continuing maintenance IS, improves patient survival in kidney transplant recipients with cancer undergoing radiotherapy. Only few retrospective studies on small cancer patient cohorts are available in this setting, but without comparison of different immunosuppression treatments. Even where immunosuppression therapy was described, patient survival seemed to be correlated only with cancer stage and type.
CONCLUSION The results of this systematic review do not support the reduction of immunosuppression dose in patients undergoing radiotherapy.
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Affiliation(s)
- Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Andrea D'Aviero
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Bruno Fionda
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Calogero Casà
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Ilaria Esposito
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Francesco Preziosi
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Anna Acampora
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome 00168, Rome, Italy
| | - Fabio Marazzi
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - György Kovács
- Università Cattolica del Sacro Cuore, Gemelli-INTERACTS, Rome, 00168 Rome, Italy
| | | | | | - Vincenzo Valentini
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Jacopo Romagnoli
- Renal Transplant Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
| | - Luca Tagliaferri
- Renal Transplant Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
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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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Romagnoli J, Tagliaferri L, Acampora A, Bianchi V, D'Ambrosio V, D'Aviero A, Esposito I, Hohaus S, Iezzi R, Lancellotta V, Maiolo E, Maiorano BA, Paoletti F, Peris K, Posa A, Preziosi F, Rossi E, Scaletta G, Schinzari G, Spagnoletti G, Tanzilli A, Scambia G, Tortora G, Valentini V, Maggiore U, Grandaliano G. Management of the kidney transplant patient with Cancer: Report from a Multidisciplinary Consensus Conference. Transplant Rev (Orlando) 2021; 35:100636. [PMID: 34237586 DOI: 10.1016/j.trre.2021.100636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Cancer is the second most common cause of mortality and morbidity in Kidney Transplant Recipients (KTRs). Immunosuppression can influence the efficacy of cancer treatment and modification of the immunosuppressive regimen may restore anti-neoplastic immune responses improving oncologic prognosis. However, patients and transplant physicians are usually reluctant to modify immunosuppression, fearing rejection and potential graft loss. Due to the lack of extensive and recognised data supporting how to manage the immunosuppressive therapy in KTRs, in the context of immunotherapy, chemotherapy, radiotherapy and loco-regional treatments, a Consensus Conference was organised under the auspices of the European Society of Organ Transplantation and the Italian Society of Organ Transplantation. The conference involved a multidisciplinary group of transplant experts in the field across Europe. METHODS The overall process included a) the formulation of 12 specific questions based on the PICO methodology, b) systematic literature review and summary for experts for each question, c) a two-day conference celebration and the collection of experts' agreements. The conference was articulated in three sessions: "Immunosuppressive therapy and immunotherapy", "Systemic therapy", "Integrated Therapy", while the final experts' agreement was collected with a televoting procedure and defined according to the majority criterion. RESULTS Twenty-six European experts attended the conference and expressed their vote. A total of 14 statements were finally elaborated and voted. Strong agreement was found for ten statements, moderate agreement for two, moderate disagreement for one and uncertainty for the last one. CONCLUSIONS The consensus statements provide guidance to transplant physicians caring for kidney transplant recipients with cancer and indicate key aspects that need to be addressed by future clinical research.
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Affiliation(s)
- Jacopo Romagnoli
- Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Trapianti di Rene, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luca Tagliaferri
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
| | - Anna Acampora
- Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Valentina Bianchi
- Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Trapianti di Rene, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Viola D'Ambrosio
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Andrea D'Aviero
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Ilaria Esposito
- Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. di Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Stefan Hohaus
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Roberto Iezzi
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. di Radiologia diagnostica e interventistica generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Valentina Lancellotta
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Elena Maiolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Brigida A Maiorano
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy; Unità di Oncologia, Fondazione Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo (FG), Italy
| | - Filippo Paoletti
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Ketty Peris
- Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. di Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Dermatologia, Roma, Italy
| | - Alessandro Posa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. di Radiologia diagnostica e interventistica generale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesco Preziosi
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Ernesto Rossi
- Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giuseppe Scaletta
- Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giovanni Schinzari
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Gionata Spagnoletti
- Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Trapianti di Rene, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia; Dipartimento di Chirurgie Specialistiche, Ch. Epato-Bilio-Pancreatica e Dei Trapianti di Fegato e Rene, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
| | - Alessandro Tanzilli
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Giovanni Scambia
- Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, UOC Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giampaolo Tortora
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Vincenzo Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Umberto Maggiore
- Dipartimento di Medicina e Chirurgia, Università di Parma, UO Nefrologia, Azienda-Ospedaliero di Parma, Parma, Italy
| | - Giuseppe Grandaliano
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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Jue JS, Alameddine M, Gonzále J, Cianci G. Risk factors, management, and survival of bladder cancer after kidney transplantation. Actas Urol Esp 2021; 45:427-438. [PMID: 34147429 DOI: 10.1016/j.acuroe.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND OBJECTIVES Kidney transplantation is associated with an increased risk of bladder cancer; however guidelines have not been established on the management of bladder cancer after kidney transplantation. MATERIALS AND METHODS A systematic literature review using PubMed was performed in accordance with the PRISMA statement to identify studies concerning the prevalence and survival of bladder cancer after kidney transplantation. The risk factors and management of bladder cancer after kidney transplantation were also reviewed and discussed. RESULTS A total of 41 studies, published between 1996 and 2018, reporting primary data on bladder cancer after kidney transplantation were identified. Marked heterogeneity in bladder cancer prevalence, time to diagnosis, non-muscle invasive/muscle-invasive bladder cancer prevalence, and survival was noted. Four studies, published between 2003 and 2017, reporting primary data on bladder cancer treated with Bacillus Calmette-Guérin (BCG) after kidney transplantation were identified. Disease-free survival, cancer-specific survival, and overall survival were similar between BCG studies (75-100%). CONCLUSIONS Carcinogen exposure that led to ESRD, BKV, HPV, immunosuppressive agents, and the immunosuppressed state likely contribute to the increased risk of bladder cancer after renal transplantation. Non-muscle invasive disease should be treated with transurethral resection. BCG can be safely used in transplant recipients and likely improves the disease course. Muscle-invasive disease should be treated with radical cystectomy, with special consideration to the dissection and urinary diversion choice. Chemotherapy and immune checkpoint inhibitors can be safely used in regionally advanced bladder cancer with potential benefit. mTOR inhibitors may reduce the risk of developing bladder cancer, and immunosuppression medications should be reduced if malignancy develops.
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Affiliation(s)
- J S Jue
- Department of Urology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New York, United States; Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - M Alameddine
- Department of Surgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Miami Transplant Institute, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Gonzále
- Department of Surgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - G Cianci
- Department of Surgery, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Miami Transplant Institute, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, United States; Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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11
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Jue J, Alameddine M, González J, Ciancio G. Risk factors, management, and survival of bladder cancer after kidney transplantation. Actas Urol Esp 2021. [PMID: 33994047 DOI: 10.1016/j.acuro.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Kidney transplantation is associated with an increased risk of bladder cancer; however guidelines have not been established on the management of bladder cancer after kidney transplantation. MATERIALS AND METHODS A systematic literature review using PubMed was performed in accordance with the PRISMA statement to identify studies concerning the prevalence and survival of bladder cancer after kidney transplantation. The risk factors and management of bladder cancer after kidney transplantation were also reviewed and discussed. RESULTS A total of 41 studies, published between 1996 and 2018, reporting primary data on bladder cancer after kidney transplantation were identified. Marked heterogeneity in bladder cancer prevalence, time to diagnosis, non-muscle invasive/muscle-invasive bladder cancer prevalence, and survival was noted. Four studies, published between 2003 and 2017, reporting primary data on bladder cancer treated with Bacillus Calmette-Guérin (BCG) after kidney transplantation were identified. Disease-free survival, cancer-specific survival, and overall survival were similar between BCG studies (75-100%). CONCLUSIONS Carcinogen exposure that led to ESRD, BKV, HPV, immunosuppressive agents, and the immunosuppressed state likely contribute to the increased risk of bladder cancer after renal transplantation. Non-muscle invasive disease should be treated with transurethral resection. BCG can be safely used in transplant recipients and likely improves the disease course. Muscle-invasive disease should be treated with radical cystectomy, with special consideration to the dissection and urinary diversion choice. Chemotherapy and immune checkpoint inhibitors can be safely used in regionally advanced bladder cancer with potential benefit. mTOR inhibitors may reduce the risk of developing bladder cancer, and immunosuppression medications should be reduced if malignancy develops.
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12
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Culty T, Goujon A, Defortescu G, Bessede T, Kleinclauss F, Boissier R, Drouin S, Branchereau J, Doerfler A, Prudhomme T, Matillon X, Verhoest G, Tillou X, Ploussard G, Rozet F, Méjean A, Timsit MO. [Localized Prostate cancer in candidates for renal transplantation and recipients of a kidney transplant: The French Guidelines from CTAFU]. Prog Urol 2021; 31:4-17. [PMID: 33423746 DOI: 10.1016/j.purol.2020.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/13/2020] [Accepted: 04/20/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To define guidelines for the management of localized prostate cancer (PCa) in kidney transplant (KTx) candidates and recipients. METHOD A systematic review (Medline) of the literature was conducted by the CTAFU to report prostate cancer epidemiology, screening, diagnosis and management in KTx candidates and recipients with the corresponding level of evidence. RESULTS KTx recipients are at similar risk for PCa as general population. Thus, PCa screening in this setting is defined according to global French guidelines from CCAFU. Systematic screening is proposed in candidates for renal transplant over 50 y-o. PCa diagnosis is based on prostate biopsies performed after multiparametric MRI and preventive antibiotics. CCAFU guidelines remain applicable for PCa treatment in KTx recipients with some specificities, especially regarding lymph nodes management. Treatment options in candidates for KTx need to integrate waiting time and access to transplantation. Current data allows the CTAFU to propose mandatory waiting times after PCa treatment in KTx candidates with a weak level of evidence. CONCLUSION These French recommendations should contribute to improve PCa management in KTx recipients and candidates, integrating oncological objectives with access to transplantation.
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Affiliation(s)
- T Culty
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - A Goujon
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - G Defortescu
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - T Bessede
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de Bicêtre, université de Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - F Kleinclauss
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHRU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - R Boissier
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de La Conception, université Aix-Marseille, 47, boulevard Baille, 13005 Marseille, France
| | - S Drouin
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de la Pitié-Salpêtrière, université Paris Sorbonne, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - J Branchereau
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Nantes, 5, allée de l'Île-Gloriette, 44093 Nantes cedex 01, France
| | - A Doerfler
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Brugmann, place A. Van Gehuchten 4, 1020 Bruxelles, Belgique
| | - T Prudhomme
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, 9, place Lange, 31300 Toulouse, France
| | - X Matillon
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - G Verhoest
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - X Tillou
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - G Ploussard
- Comité de cancérologie de l'Association française d'urologie (CCAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - F Rozet
- Comité de cancérologie de l'Association française d'urologie (CCAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'urologie, institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie (CCAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - M-O Timsit
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France; PARCC, INSERM, équipe labellisée par la Ligue Contre le Cancer, université de Paris, 56, rue Leblanc, 75015 Paris, France.
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Abstract
PURPOSE OF REVIEW The aim of this article is to review incidence, risk factors, and optimal management of de-novo urothelial carcinoma in transplant recipients. RECENT FINDINGS There is a two to three-fold increased risk for de-novo malignant tumors after solid-organ transplantation, but there is currently no consensus regarding optimal management of de-novo urothelial carcinoma in transplanted patients. Known risk factors include polyomavirus BK, aristolochic acid, and smoking. Data suggest a higher rate of high-grade tumors, as well as predominantly higher stage at primary diagnosis, for both NMIBC and muscle-invasive bladder cancer (MIBC). Treatment for NMIBC includes TURB, mitomycin, and Bacille de Calmette-Guérin instillation with special concern to the immunosuppressive regime. Treatment of MIBC or advanced urothelial carcinoma includes radical cystectomy with chemotherapy if the patient is eligible. A screening should be performed in all transplant recipients, to allow early diagnosis. SUMMARY De-novo urothelial carcinoma in transplant recipients is more frequent than in the general population and these tumors were more likely to be high-grade tumors and diagnosed at an advanced stage. There is very little information available on the optimal treatment for these patients. However, aggressive treatment and a strict management according the given recommendations are of the utmost importance.
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14
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Jiang S, Regmi S, Jackson S, Calvert C, Jarosek S, Pruett T, Warlick C. Risk of Genitourinary Malignancy in the Renal Transplant Patient. Urology 2020; 145:152-158. [PMID: 32763322 DOI: 10.1016/j.urology.2020.06.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/26/2020] [Accepted: 06/09/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To better understand the risk of genitourinary malignancies in the renal transplant patient. Currently, no consensus exists regarding screening and intervention, with much of the clinical decision-making based on historical practices established before recent progress in immunosuppression protocols and in genitourinary cancer diagnosis and management. METHODS A database of all solid organ transplants performed at the University of Minnesota from 1984 to 2019 was queried for renal transplant recipients in whom development of subsequent urologic malignancies (prostate, bladder, renal, penile, and testicular cancer) was found. RESULTS Among 6172 renal transplant recipients examined, cumulative incidence of all cancers of genitourinary etiology are presented over an average follow-up time of 10 years. Kidney cancer (combined graft and native), prostate cancer, and bladder cancer each demonstrated respective 30-year incidence of 4.6%, 8.7%, and 1.5% from the time of transplant. By comparison, age-matched data from the Surveillance, Epidemiology, and End Results database demonstrated 30-year cumulative incidence of 1.1%, 11.1%, and 1.7% for kidney cancer, prostate cancer, and bladder cancer respectively. The predominant genitourinary cancer was renal cell cancer, both of the native and of the transplanted kidney (native, n = 64; transplanted, n =11), followed by prostate cancer (n = 63), and bladder cancer (n = 37). CONCLUSION In this closely followed cohort of renal transplant recipients, renal cancer occurs at a higher incidence rate than in the non-transplanted population, while a lower rate of prostate cancer was found, with bladder cancer demonstrating a comparable cumulative incidence between transplant patients and the national age-matched population.
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Affiliation(s)
- Song Jiang
- University of Minnesota, Department of Urology, Minneapolis, MN; Minneapolis Veterans Affairs Medical Center, Department of Urology, Minneapolis, MN.
| | - Subodh Regmi
- University of Minnesota, Department of Urology, Minneapolis, MN
| | - Scott Jackson
- Complex Care Analytics, Fairview Health Services, Minneapolis, MN
| | - Collin Calvert
- University of Minnesota School of Public Health, Division of Epidemiology & Community Health, Minneapolis, MN
| | - Stephanie Jarosek
- University of Minnesota School of Public Health, Division of Epidemiology & Community Health, Minneapolis, MN
| | - Timothy Pruett
- University of Minnesota, Department of Surgery, Division of Transplantation, Minneapolis, MN
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Cuenca AG, Rosales I, Lee RJ, Wu CL, Colvin R, Feldman AS, Efstathiou JA, Tolkoff-Rubin N, Elias N. Resolution of a High Grade and Metastatic BK Polyomavirus-Associated Urothelial Cell Carcinoma Following Radical Allograft Nephroureterectomy and Immune Checkpoint Treatment: A Case Report. Transplant Proc 2020; 52:2720-2725. [PMID: 32741665 DOI: 10.1016/j.transproceed.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/04/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND BK viral infection in the posttransplant setting continues to cause serious morbidity with effects ranging from allograft nephropathy and dysfunction to urothelial malignancy. RESULTS In this report, we present a patient that developed BK-associated nephropathy and, 6 years later, locally advanced urothelial malignancy in the renal allograft with nodal, muscle, and extremity involvement. Following radical allograft nephroureterectomy, he was treated with palliative radiation and the immune checkpoint inhibitor atezolizumab. Follow-up imaging at 1 year demonstrated radiographic complete response. CONCLUSIONS This report supports the growing body of evidence supporting the association of urothelial malignancy and BK virus infection in renal transplant recipients. Further, it highlights the novel application of immune checkpoint inhibitors in the treatment of advanced posttransplant malignancy, in particular when the allograft is removed and the tumor is possibly of donor origin.
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Affiliation(s)
- Alex G Cuenca
- Department of Surgery/Division of Transplant Surgery, Massachusetts General Hospital, Boston, MA; Department of Surgery, Boston Children's Hospital, Boston, MA.
| | - Ivy Rosales
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Richard J Lee
- Department of Medicine/Division of Hematology Oncology, Massachusetts General Hospital, Boston, MA
| | - Chin-Lee Wu
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Robert Colvin
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Adam S Feldman
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Nina Tolkoff-Rubin
- Department of Medicine/Division of Nephrology, Massachusetts General Hospital, Boston, MA
| | - Nahel Elias
- Department of Surgery/Division of Transplant Surgery, Massachusetts General Hospital, Boston, MA
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Motta G, Ferraresso M, Lamperti L, Di Paolo D, Raison N, Perego M, Favi E. Treatment options for localised renal cell carcinoma of the transplanted kidney. World J Transplant 2020; 10:147-161. [PMID: 32742948 PMCID: PMC7360528 DOI: 10.5500/wjt.v10.i6.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/07/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023] Open
Abstract
Currently, there is no consensus among the transplant community about the treatment of renal cell carcinoma (RCC) of the transplanted kidney. Until recently, graftectomy was universally considered the golden standard, regardless of the characteristics of the neoplasm. Due to the encouraging results observed in native kidneys, conservative options such as nephron-sparing surgery (NSS) (enucleation and partial nephrectomy) and ablative therapy (radiofrequency ablation, cryoablation, microwave ablation, high-intensity focused ultrasound, and irreversible electroporation) have been progressively used in carefully selected recipients with early-stage allograft RCC. Available reports show excellent patient survival, optimal oncological outcome, and preserved renal function with acceptable complication rates. Nevertheless, the rarity and the heterogeneity of the disease, the number of options available, and the lack of long-term follow-up data do not allow to adequately define treatment-specific advantages and limitations. The role of active surveillance and immunosuppression management remain also debated. In order to offer a better insight into this difficult topic and to help clinicians choose the best therapy for their patients, we performed and extensive review of the literature. We focused on epidemiology, clinical presentation, diagnostic work up, staging strategies, tumour characteristics, treatment modalities, and follow-up protocols. Our research confirms that both NSS and focal ablation represent a valuable alternative to graftectomy for kidney transplant recipients with American Joint Committee on Cancer stage T1aN0M0 RCC. Data on T1bN0M0 lesions are scarce but suggest extra caution. Properly designed multi-centre prospective clinical trials are warranted.
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Affiliation(s)
- Gloria Motta
- Urology, IRCCS Policlinico San Donato, San Donato Milanese 27288, Italy
| | - Mariano Ferraresso
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Luca Lamperti
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Dhanai Di Paolo
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Nicholas Raison
- MRC Centre for Transplantation, King’s College London, London WC2R 2LS, United Kingdom
| | - Marta Perego
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Evaldo Favi
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
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Ileana PÁS, Rubi RP, Javier LRF, Sagrario MGMD, Haydeé FBC. Pelvic radiation therapy with volumetric modulated arc therapy and intensity-modulated radiotherapy after renal transplant: A report of 3 cases. Rep Pract Oncol Radiother 2020; 25:548-555. [PMID: 32494227 DOI: 10.1016/j.rpor.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/23/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022] Open
Abstract
Aim Describe characteristics and outcomes of three patients treated with pelvic radiation therapy after kidney transplant. Background The incidence of pelvic cancers in kidney transplant (KT) recipients is rising. Currently it is the leading cause of death. Moreover, treatment is challenging because anatomical variants, comorbidities, and associated treatments, which raises the concern of using radiotherapy (RT). RT has been discouraged due to the increased risk of urethral/ureteral stricture and KT dysfunction. Materials and methods We reviewed the electronic health records and digital planning system of patients treated with pelvic RT between December 2013 and December 2018 to identify patients with previous KT. Cases description We describe three successful cases of KT patients in which modern techniques allowed full standard RT for pelvic malignances (2 prostate and 1 vaginal cancer) with or without elective pelvic nodal RT, without allograft toxicity at short and long follow-up (up to 60 months). Conclusion When needed, RT modern techniques remain a valid option with excellent oncologic results and acceptable toxicity. Physicians should give special considerations to accomplish all OAR dose constraints in the patient's specific setting. Recent publications recommend KT mean dose <4 Gy, but graft proximity to CTV makes this unfeasible. We present 2 cases where dose constraint was not achieved, and to a short follow-up of 20 months renal toxicity has not been documented. We recommend the lowest possible mean dose to the KT, but never compromising the CTV coverage, since morbimortality from recurrent or progressive cancer disease outweighs the risk of graft injury.
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Key Words
- BF, Biochemical failure
- BT, Brachytherapy
- C3D-RT, Conformal three-dimensional radiation therapy
- CBCT, Cone-beam computed tomography
- CCa, Cervix cancer
- Dmax, Maximum dose
- Dmean, Mean dose
- Dmin, Minimum dose
- Dx, Dose (in Gy) receiving x% of a volume or more
- EBRT, External beam radiation therapy
- EQD2, Equivalent dose in 2-Gy fractions
- ESKD, End-stage kidney disease
- FU, Follow-up
- HPV, Human papillomavirus
- IBT, Intracavitary brachytherapy
- IMRT, Intensity-modulated radiation therapy
- KT, Kidney transplant
- Kidney allograft
- LRDRT, Living related donor renal transplantation
- MMF, Mycophenolate mofetil
- NED, No evidence of disease
- OAR, Organs at risk
- OS, Overall survival
- PCa, Prostate cancer
- PDN, Prednisone
- PP, Post-prostatectomy
- PSA, Prostate-specific antigen
- PTV, Planning target volume
- Pelvic radiotherapy
- Prostate cancer
- RR, Risk ratio
- RT, Radiation therapy
- Renal transplant
- SCCVa, Squamous cell carcinoma of the vagina
- SIR, Standardized Incidence Ratio
- TBI, Total body irradiation
- VCa, Vaginal cancer
- VMAT, Volumetric Modulated Arc Therapy
- Vaginal cancer
- Vx, Volume (in percentage) receiving x dose or more (in Gy)
- fr, Fractions
- mo, Months
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Affiliation(s)
- Pérez Álvarez Sandra Ileana
- Radiotherapy and Medical Physics Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. 15 Vasco de Quiroga, Belisario Domínguez, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Ramos Prudencio Rubi
- Radiotherapy and Medical Physics Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. 15 Vasco de Quiroga, Belisario Domínguez, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
| | - Lozano Ruiz Francisco Javier
- Department of Radiation Oncology, Médica Sur Hospital. 150 Puente de Piedra, Toriello Guerra, Tlalpan, Mexico City, 14050, Mexico
| | | | - Flores Balcazar Christian Haydeé
- Radiotherapy and Medical Physics Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. 15 Vasco de Quiroga, Belisario Domínguez, Sección XVI, Tlalpan, Mexico City, 14080, Mexico
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18
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Favi E, Raison N, Ambrogi F, Delbue S, Clementi MC, Lamperti L, Perego M, Bischeri M, Ferraresso M. Systematic review of ablative therapy for the treatment of renal allograft neoplasms. World J Clin Cases 2019; 7:2487-2504. [PMID: 31559284 PMCID: PMC6745334 DOI: 10.12998/wjcc.v7.i17.2487] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/01/2019] [Accepted: 08/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To date, there are no guidelines on the treatment of solid neoplasms in the transplanted kidney. Historically, allograft nephrectomy has been considered the only reasonable option. More recently, nephron-sparing surgery (NSS) and ablative therapy (AT) have been proposed as alternative procedures in selected cases.
AIM To review outcomes of AT for the treatment of renal allograft tumours.
METHODS We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 Checklist. PubMed was searched in March 2019 without time restrictions for all papers reporting on radiofrequency ablation (RFA), cryoablation (CA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), and irreversible electroporation (IRE) of solid tumours of the kidney allograft. Only original manuscripts describing actual cases and edited in English were considered. All relevant articles were accessed in full text. Additional searches included all pertinent references. Selected studies were also assessed for methodological quality using a tool based on a modification of the Newcastle Ottawa scale. Data on recipient characteristics, transplant characteristics, disease characteristics, treatment protocols, and treatment outcomes were extracted and analysed. Given the nature and the quality of the studies available (mostly retrospective case reports and small retrospective uncontrolled case series), a descriptive summary was provided.
RESULTS Twenty-eight relevant studies were selected describing a total of 100 AT procedures in 92 patients. Recipient age at diagnosis ranged from 21 to 71 years whereas time from transplant to diagnosis ranged from 0.1 to 312 mo. Most of the neoplasms were asymptomatic and diagnosed incidentally during imaging carried out for screening purposes or for other clinical reasons. Preferred diagnostic modality was Doppler-ultrasound scan followed by computed tomography scan, and magnetic resonance imaging. Main tumour types were: papillary renal cell carcinoma (RCC) and clear cell RCC. Maximal tumour diameter ranged from 5 to 55 mm. The vast majority of neoplasms were T1a N0 M0 with only 2 lesions staged T1b N0 M0. Neoplasms were managed by RFA (n = 78), CA (n = 15), MWA (n = 3), HIFU (n = 3), and IRE (n = 1). Overall, 3 episodes of primary treatment failure were reported. A single case of recurrence was identified. Follow-up ranged from 1 to 81 mo. No cancer-related deaths were observed. Complication rate was extremely low (mostly < 10%). Graft function remained stable in the majority of recipients. Due to the limited sample size, no clear benefit of a single procedure over the other ones could be demonstrated.
CONCLUSION AT for renal allograft neoplasms represents a promising alternative to radical nephrectomy and NSS in carefully selected patients. Properly designed clinical trials are needed to validate this therapeutic approach.
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Affiliation(s)
- Evaldo Favi
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Nicholas Raison
- MRC Centre for Transplantation, King’s College London, London WC2R 2LS, United Kingdom
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
| | - Serena Delbue
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20100, Italy
| | - Maria Chiara Clementi
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Luca Lamperti
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Marta Perego
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Matteo Bischeri
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Mariano Ferraresso
- Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan 20122, Italy
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Iezzi R, Posa A, Carchesio F, Romagnoli J, Salerno MP, Citterio F, Manfredi R. Radiofrequency thermal ablation of renal graft neoplasms: A literature review. Transplant Rev (Orlando) 2019; 33:161-165. [DOI: 10.1016/j.trre.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/23/2019] [Accepted: 01/31/2019] [Indexed: 02/06/2023]
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20
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Di Candio G, Porcelli F, Campatelli A, Guadagni S, Vistoli F, Morelli L. High-Intensity Focused Ultrasonography and Radiofrequency Ablation of Renal Cell Carcinoma Arisen in Transplanted Kidneys: Single-Center Experience With Long-Term Follow-Up and Review of Literature. JOURNAL OF ULTRASOUND IN MEDICINE 2019; 38:2507-2513. [PMID: 30690771 DOI: 10.1002/jum.14938] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/06/2018] [Accepted: 12/19/2018] [Indexed: 02/05/2023]
Abstract
The purpose of this article is to retrospectively evaluate the long-term outcome of patients treated with percutaneous thermoablation for renal cell carcinomas that have arisen in kidney grafts. Between April 2008 and February 2011, we treated 3 patients with renal cell carcinoma on a transplanted kidney: 2 cases were treated with high-intensity focused ultrasonography and 1 patient with radio frequency ablation. Postprocedural ultrasonography did not reveal any complications, and contrast-enhanced ultrasonography showed an avascular area in the treated nodules. None of the patients had recurrent tumors during a long-term clinical and radiologic follow-up (81, 73, and 43 months, respectively).
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Affiliation(s)
| | | | - Alessandro Campatelli
- Diagnostic and Interventional Ultrasound in Transplants Unit, University of Pisa, Pisa, Italy
| | | | - Fabio Vistoli
- General and Transplantation Surgery Unit, Pisa, Italy
| | - Luca Morelli
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
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21
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Ochoa-López JM, Gabilondo-Pliego B, Collura-Merlier S, Herrera-Cáceres JO, de Zavaleta MS, Rodríguez-Covarrubias FT, Feria-Bernal G, Gabilondo-Navarro F, Castillejos-Molina RA. Incidence and treatment of malignant tumors of the genitourinary tract in renal transplant recipients. Int Braz J Urol 2018; 44:874-881. [PMID: 29757570 PMCID: PMC6237530 DOI: 10.1590/s1677-5538.ibju.2017.0471] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 04/04/2018] [Indexed: 01/20/2023] Open
Abstract
Purpose: To provide data of the incidence and management of common urological malignancies in renal transplant recipients. Materials and Methods: We conducted a retrospective analysis of a prospective database from August 1967 to August 2015. A descriptive analysis of the sample was performed. Results: Among 1256 consecutive RTR a total of 88 patients developed malignancies (7%). There were 18 genitourinary tumors in the 16 patients (20.45 % of all malignant neoplasms), incidence of 1.27%. The most common neoplasm encounter was renal cancer (38.8%), followed by urothelial carcinoma (33.3%). Median follow-up of transplantation was 197 months (R, 36-336). Mean time from RT to cancer diagnosis 89±70 months (R, 12-276). CsA and AZA was the most common immunosuppression regimen in 68.75%. Mean follow-up after diagnosis was 103±72 months (R 10-215). Recurrence free survival rate of 100%. Overall survival of 89.5% of the sample; there were two non-related cancer deaths during follow-up. Conclusions: The incidence of neoplasms in RTR was lower than in other series, with favorable functional and oncologic results after treatment. This suggests that actions to reduce the risk of these malignancies as well as a strict follow-up are mandatory for an early detection and treatment.
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Affiliation(s)
- Juan Manuel Ochoa-López
- Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México
| | | | - Sylvain Collura-Merlier
- Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México
| | - Jaime O Herrera-Cáceres
- Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México
| | | | | | - Guillermo Feria-Bernal
- Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México
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22
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Zeng J, Christiansen A, Pooli A, Qiu F, LaGrange CA. Safety and Clinical Outcomes of Robot-Assisted Radical Prostatectomy in Kidney Transplant Patients: A Systematic Review. J Endourol 2018; 32:935-943. [PMID: 30039723 DOI: 10.1089/end.2018.0394] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate the safety and outcomes of robot-assisted radical prostatectomy (RARP) in renal transplant recipients (RTRs) based on available literature. MATERIALS AND METHODS A literature search was performed using PubMed, Embase, and Web of Science through "robot" AND "prostatectomy" AND "transplant." Three authors separately reviewed the records to select the relevant articles with any discrepancies solved by open discussion. Patient age, prostate-specific antigen, Gleason score, and tumor stage were recorded as well as intraoperative and postoperative complications, length of stay, surgical margin status, and disease recurrence, if provided. The operative techniques and modification/adjustments to standard port placements were also reviewed. We also include our case report in this review. RESULTS We retrieved 10 articles reporting clinical data on RARP for kidney transplant patients, including 5 case series (level 4) and 5 case reports (level 4). A total of 35 kidney transplant recipients undergoing RARP were analyzed in this systematic review, one case in our institution included. None of the cases had major technical difficulties precluding the operation. Technical modifications to the standard technique were described in 10 of the 11 articles specifically including modifications to port placement (54% of patients), development of the space of Retzius (60% of patients), and performance of lymphadenectomy. Mean operative time was 220 minutes. Perioperative complication rate was 17.1% (6 of 35 patients), with only one Clavien III or greater complication. The rate of positive surgical margins was found to be 31.4%. Data on biochemical recurrence revealed a combined rate of 18.1%. CONCLUSIONS RARP is technically feasible for treating localized prostate cancer in RTRs. Graft function did not deteriorate in any patient. Modifications to the standard technique should be considered specifically for port placement, development of the space of Retzius, and performance of lymphadenectomy. Oncologic outcomes remain difficult to interpret given the small number of reported cases.
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Affiliation(s)
- Jiping Zeng
- 1 College of Medicine, University of Nebraska Medical Center , Omaha, Nebraska
| | - Andrew Christiansen
- 2 Division of Urology, University of Nebraska Medical Center , Omaha, Nebraska
| | - Aydin Pooli
- 3 Department of Urology, David Geffen School of Medicine at University of California , Los Angeles, California
| | - Fang Qiu
- 4 Department of Biostatistics, College of Public Health, University of Nebraska Medical Center , Omaha, Nebraska
| | - Chad A LaGrange
- 2 Division of Urology, University of Nebraska Medical Center , Omaha, Nebraska
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23
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Antunes H, Tavares-da-Silva E, Oliveira R, Carvalho J, Parada B, Bastos C, Figueiredo A. De Novo Urologic Malignancies in Renal Transplant Recipients. Transplant Proc 2018; 50:1348-1354. [DOI: 10.1016/j.transproceed.2018.02.086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/10/2018] [Accepted: 02/23/2018] [Indexed: 01/20/2023]
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24
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Hevia V, Boissier R, Rodríguez-Faba Ó, Fraser-Taylor C, Hassan-Zakri R, Lledo E, Regele H, Buddde K, Figueiredo A, Olsburgh J, Breda A. Management of Localised Prostate Cancer in Kidney Transplant Patients: A Systematic Review from the EAU Guidelines on Renal Transplantation Panel. Eur Urol Focus 2018; 4:153-162. [DOI: 10.1016/j.euf.2018.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/03/2018] [Accepted: 05/16/2018] [Indexed: 12/15/2022]
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25
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Marra G, Dalmasso E, Agnello M, Munegato S, Bosio A, Sedigh O, Biancone L, Gontero P. Prostate cancer treatment in renal transplant recipients: a systematic review. BJU Int 2017; 121:327-344. [DOI: 10.1111/bju.14018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Giancarlo Marra
- Department of Urology; Molinette Hospital; University of Studies of Turin; Turin Italy
| | - Ettore Dalmasso
- Department of Urology; Molinette Hospital; University of Studies of Turin; Turin Italy
| | - Marco Agnello
- Department of Urology; Molinette Hospital; University of Studies of Turin; Turin Italy
| | - Stefania Munegato
- Department of Urology; Molinette Hospital; University of Studies of Turin; Turin Italy
| | - Andrea Bosio
- Department of Urology; Molinette Hospital; University of Studies of Turin; Turin Italy
| | - Omidreza Sedigh
- Department of Urology; Molinette Hospital; University of Studies of Turin; Turin Italy
| | - Luigi Biancone
- Department of Nephrology and Renal Transplantation; Molinette Hospital; University of Studies of Turin; Turin Italy
| | - Paolo Gontero
- Department of Urology; Molinette Hospital; University of Studies of Turin; Turin Italy
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26
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Griffith JJ, Amin KA, Waingankar N, Lerner SM, Delaney V, Ames SA, Badani K, Palese MA, Mehrazin R. Solid Renal Masses in Transplanted Allograft Kidneys: A Closer Look at the Epidemiology and Management. Am J Transplant 2017; 17:2775-2781. [PMID: 28544435 DOI: 10.1111/ajt.14366] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/05/2017] [Accepted: 05/06/2017] [Indexed: 01/25/2023]
Abstract
The objective of this review is to explore the available literature on solid renal masses (SRMs) in transplant allograft kidneys to better understand the epidemiology and management of these tumors. A literature review using PubMed was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Fifty-six relevant studies were identified from 1988 to 2015. A total of 174 SRMs in 163 patients were identified, with a mean tumor size of 2.75 cm (range 0.5-9.0 cm). Tumor histology was available for 164 (94.3%) tumors: clear cell renal cell carcinoma (RCC; 45.7%), papillary RCC (42.1%), chromophobe RCC (3%), and others (9.1%). Tumors were managed by partial nephrectomy (67.5%), radical nephrectomy (19.4%), percutaneous radiofrequency ablation (10.4%), and percutaneous cryoablation (2.4%). Of the 131 patients (80.3%) who underwent nephron-sparing interventions, 10 (7.6%) returned to dialysis and eight (6.1%) developed tumor recurrence over a mean follow-up of 2.85 years. Of the 110 patients (67.5%) who underwent partial nephrectomy, 3.6% developed a local recurrence during a mean follow-up of 3.12 years. The current management of SRMs in allograft kidneys mirrors management in the nontransplant population, with notable findings including an increased rate of papillary RCC and similar recurrence rates after partial nephrectomy in the transplant population despite complex surgical anatomy.
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Affiliation(s)
- J J Griffith
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - K A Amin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - N Waingankar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - S M Lerner
- Transplant Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - V Delaney
- Transplant Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - S A Ames
- Transplant Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - M A Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - R Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
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27
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Kleinclauss F, Thuret R, Murez T, Timsit M. Transplantation rénale et cancers urologiques. Prog Urol 2016; 26:1094-1113. [DOI: 10.1016/j.purol.2016.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 08/22/2016] [Indexed: 12/18/2022]
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28
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Renal cell carcinoma in kidney allografts: histologic types, including biphasic papillary carcinoma. Hum Pathol 2016; 57:28-36. [PMID: 27396934 DOI: 10.1016/j.humpath.2016.06.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/03/2016] [Accepted: 06/29/2016] [Indexed: 12/12/2022]
Abstract
Kidney transplant recipients are at increased risk for malignancy, with about 5% incidence of cancer in native end-stage kidneys. Carcinoma in the renal allograft is far less common. Prior studies have demonstrated a propensity for renal cell carcinomas (RCCs) of papillary subtypes in end-stage kidneys, and perhaps in allograft kidneys, but most allograft studies lack detailed pathologic review and predate the current classification system. We reviewed our experience with renal carcinoma in kidney allografts at 2 academic centers applying the International Society of Urological Pathology classification, informed by immunohistochemistry. The incidence of renal allograft carcinoma was about 0.26% in our population. Of 12 allograft carcinomas, 6 were papillary (50%), 4 were clear cell (33%), 1 was clear cell (tubulo)papillary, and 1 chromophobe. Two of the papillary carcinomas had distinctive biphasic glomeruloid architecture matching the newly named "biphasic squamoid alveolar" pattern and were difficult to classify on core biopsies. The 2 cell types had different immunophenotypes in our hands (eosinophilic cells: RCC-/CK34betaE12+ weight keratin +/cyclin D1+; clear cells: RCC+/cytokeratin high molecular weight negative to weak/cyclin D1-). None of the patients experienced cancer recurrences or metastasis. Our study confirms the predilection for papillary RCCs in kidney allografts and highlights the occurrence of rare morphologic variants. Larger studies are needed with careful pathologic review, which has been lacking in the literature.
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29
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Pettenati C, Jannot AS, Hurel S, Verkarre V, Kreis H, Housset M, Legendre C, Méjean A, Timsit MO. Prostate cancer characteristics and outcome in renal transplant recipients: results from a contemporary single center study. Clin Transplant 2016; 30:964-71. [DOI: 10.1111/ctr.12773] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Caroline Pettenati
- Department of Urology and Transplant Surgery; Hôpital européen Georges-Pompidou, AP-HP; Paris France
- Université Paris Descartes; Paris France
| | - Anne-Sophie Jannot
- Université Paris Descartes; Paris France
- Department of Statistics, Computing and Public Health; Hôpital européen Georges-Pompidou, AP-HP; Paris France
| | - Sophie Hurel
- Department of Urology and Transplant Surgery; Hôpital européen Georges-Pompidou, AP-HP; Paris France
- Université Paris Descartes; Paris France
| | - Virginie Verkarre
- Université Paris Descartes; Paris France
- Department of Pathology; Hôpital Necker, AP-HP; Paris France
| | - Henri Kreis
- Université Paris Descartes; Paris France
- Department of Nephrology and Transplantation; Hôpital Necker, AP-HP; Paris France
| | - Martin Housset
- Université Paris Descartes; Paris France
- Department of Onco-Radiotherapy; Hôpital européen Georges-Pompidou, AP-HP; Paris France
| | - Christophe Legendre
- Université Paris Descartes; Paris France
- Department of Nephrology and Transplantation; Hôpital Necker, AP-HP; Paris France
| | - Arnaud Méjean
- Department of Urology and Transplant Surgery; Hôpital européen Georges-Pompidou, AP-HP; Paris France
- Université Paris Descartes; Paris France
| | - Marc-Olivier Timsit
- Department of Urology and Transplant Surgery; Hôpital européen Georges-Pompidou, AP-HP; Paris France
- Université Paris Descartes; Paris France
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30
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Urothelial Cancer in Renal Transplant Recipients: Incidence, Risk Factors, and Oncological Outcome. Urology 2016; 88:104-10. [DOI: 10.1016/j.urology.2015.10.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 09/24/2015] [Accepted: 10/01/2015] [Indexed: 12/23/2022]
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31
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Polyomavirus large T antigen is prevalent in urothelial carcinoma post–kidney transplant. Hum Pathol 2016; 48:122-31. [DOI: 10.1016/j.humpath.2015.09.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/03/2015] [Accepted: 09/18/2015] [Indexed: 01/08/2023]
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32
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Medani S, O'Kelly P, O'Brien KM, Mohan P, Magee C, Conlon P. Bladder cancer in renal allograft recipients: risk factors and outcomes. Transplant Proc 2015; 46:3466-73. [PMID: 25498074 DOI: 10.1016/j.transproceed.2014.06.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/13/2014] [Accepted: 06/17/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Solid organ transplant recipients have an increased cancer risk owing to immunosuppression and oncogenic viral infections. We report on the incidence and types of bladder cancer in kidney transplant recipients in Ireland, describing possible additional risk factors and outcomes in these patients. METHODS We identified kidney transplant recipients diagnosed with de novo bladder cancer between January 1, 1994, and July 31, 2012, by integrating data from the Irish National Cancer Registry and National Renal Transplant Registry. We calculated the standardized incidence ratio (SIR) and examined patient and tumor characteristics and 1-year survival rate. RESULTS Fifteen patients were diagnosed with de novo bladder cancer during the study period, representing 0.48% of kidney transplant recipients. The SIR was 2.5 (95% CI, 1.4-4.2; P < .001). The mean interval between transplantation and diagnosis of bladder tumor was 8.6 years and mean age at time of diagnosis was 55.7 years. Sixty percent of patients were male. The tumor types were transitional cell carcinoma (9 patients), squamous cell carcinoma (3 patients), adenocarcinoma (1 patient), carcinoma in situ (1 patient), and diffuse large B-cell lymphoma (1 patient). Beside immunosuppression, risk factors associated with bladder cancer were urogenital disease (6 patients), cyclophosphamide exposure (2 patients), BK nephropathy (1 patient), analgesic nephropathy (1 patient), and extensive smoking (1 patient). Eight patients underwent radical cystectomy for invasive tumors, with resection of other pelvic organs in 7 patients. Mortality rate within the first year was 40%. CONCLUSION Bladder cancer occurred more commonly in kidney transplant recipients with a predominance of aggressive tumors and a high mortality. In patients with preexisting risk factors such as urologic abnormalities and cyclophosphamide exposure careful assessment before transplantation and vigilant monitoring posttransplantation with a low threshold for cystoscopy may improve outcomes.
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Affiliation(s)
- S Medani
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland.
| | - P O'Kelly
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland
| | | | - P Mohan
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland
| | - C Magee
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland
| | - P Conlon
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland
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Saleeb R, Faragalla H, Yousef GM, Stewart R, Streutker CJ. Malignancies arising in allograft kidneys, with a first reported translocation RCC post-transplantation: A case series. Pathol Res Pract 2015; 211:584-7. [PMID: 26008778 DOI: 10.1016/j.prp.2015.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 04/11/2015] [Accepted: 04/17/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND The increased risk of malignancy in the post-renal transplant population has been well documented. Renal carcinoma is more common in this population, usually arising in native kidneys. Rarely, tumors arise in the transplanted kidney. Our case series reports four cases of malignancy in allograft kidneys, one of which is a first reported case of translocation RCC in a transplanted kidney. METHODS The renal transplantation database (1584 patients) at St. Michael's Hospital was reviewed for malignancies arising in allograft kidneys: reports and pathology slides were reviewed. RESULTS Four cases of malignancies arising in the allograft kidney were identified among our kidney transplant population. One patient developed a high grade urothelial carcinoma in the donor kidney post BK virus infection. The other 3 cases were renal cell carcinomas: one clear cell renal cell carcinoma, one translocation renal cell carcinoma, and one papillary renal cell carcinoma. The translocation renal cell cancer had confirmed TFE3 protein over-expression by immunohistochemistry. Molecular testing of the tumors in all 4 cases identified two separate genetic profiles, favored to represent tumors arising from donor tissues along with infiltrating recipient lymphocytes. DISCUSSION Previous reports suggested that epithelial malignancies in allograft kidneys are rare. We identified 4 such tumors in 1584 transplant patients. Further, we identified the first reported case of translocation RCC in an allograft kidney. While the rate of malignancy in allograft kidneys is low, screening of the donor kidneys by ultrasound and/or urine cytology may be of use in detecting these lesions.
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Affiliation(s)
- R Saleeb
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - H Faragalla
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - G M Yousef
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - R Stewart
- Department of Urology, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - C J Streutker
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
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Wang Z, Vathsala A, Tiong HY. Haematuria in postrenal transplant patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:292034. [PMID: 25918706 PMCID: PMC4395992 DOI: 10.1155/2015/292034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 12/25/2022]
Abstract
Haematuria has a prevalence of 12% in the postrenal transplant patient population. It heralds potentially dangerous causes which could threaten graft loss. It is important to consider causes in light of the unique, urological, and immunological standpoints of these patients. We review the literature on common causes of haematuria in postrenal transplant patients and suggest the salient approach to the evaluation of this condition. A major cause of haematuria is urinary tract infections. There should be a higher index of suspicion for mycobacterial, fungal, and viral infection in this group of immunosuppressed patients. Measures recommended in the prevention of urinary tract infections include early removal of foreign bodies as well as prophylactic antibiotics during the early transplant phase. Another common cause of haematuria is that of malignancies, in particular, renal cell carcinomas. When surgically managing cancer in the setting of a renal transplant, one has to be mindful of the limited retropubic space and the need to protect the anastomoses. Other causes include graft rejections, recurrences of primary disease, and calculus formation. It is important to perform a comprehensive evaluation with the aid of an experienced multidisciplinary transplant team.
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Affiliation(s)
- Ziting Wang
- Department of Urology, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
| | - Anantharaman Vathsala
- Division of Nephrology, Department of Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
- National University Centre for Organ Transplantation, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
| | - Ho Yee Tiong
- Department of Urology, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
- National University Centre for Organ Transplantation, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
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Rodríguez Faba O, Breda A, Gausa L, Palou J, Villavicencio H. [De novo urologic tumors in kidney transplant patients]. Actas Urol Esp 2015; 39:122-7. [PMID: 24996779 DOI: 10.1016/j.acuro.2014.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/12/2014] [Indexed: 01/20/2023]
Abstract
CONTEXT The ability of a transplant recipient to accept a graft depends on the ability of immunosuppressive drugs to regulate the immune system. Such treatments have been associated with tumor promotion and progression. EVIDENCE ACQUISITION A systematic literature review was carried out. Electronic searches were performed in PubMed database. The searching criterion was "urological tumors in kidney transplant recipients". The most important issues regarding incidence, urological tumor-specific features, and relevant ones about the treatment are summarized. SYNTHESIS OF EVIDENCE In renal transplant, 15% of all tumors are urological neoplasias; furthermore, they are the leading neoplastic cause of death. In transplant population the incidence rate of renal cell carcinoma (RCC), transitional cell bladder carcinoma (TCBC), testicular carcinoma (TC) and prostate cancer are increased 15, 3, 3 and 2 times respectively. Treatments used in transplant patients are similar to those employed in the general population:radical nephrectomy for the native kidney and conservative surgery for the graft are indicated for RCC. Radical prostatectomy is technically feasible for localized PC.Regarding to transitional cell carcinoma BCG or MMC is not contraindicated. CONCLUSIONS The incidence rate of cancer has increased among transplant population. These tumors can be managed following the same criteria than in general population. Because in this population the prognosis is worse for the immunosuppression, closer monitoring is required.
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Affiliation(s)
- O Rodríguez Faba
- Unidad de Trasplante Renal, Servicio de Urología, Fundació Puigvert, Barcelona, España; Unidad de Urología Oncológica, Servicio de Urología, Fundació Puigvert, Barcelona, España.
| | - A Breda
- Unidad de Trasplante Renal, Servicio de Urología, Fundació Puigvert, Barcelona, España; Unidad de Urología Oncológica, Servicio de Urología, Fundació Puigvert, Barcelona, España
| | - L Gausa
- Unidad de Trasplante Renal, Servicio de Urología, Fundació Puigvert, Barcelona, España; Unidad de Urología Oncológica, Servicio de Urología, Fundació Puigvert, Barcelona, España
| | - J Palou
- Unidad de Urología Oncológica, Servicio de Urología, Fundació Puigvert, Barcelona, España
| | - H Villavicencio
- Unidad de Urología Oncológica, Servicio de Urología, Fundació Puigvert, Barcelona, España
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Rodríguez Faba O, Breda A, Gausa L, Palou J, Villavicencio H. De novo urologic tumors in kidney transplant patients. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.acuroe.2014.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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BK virus-associated urothelial carcinoma of a ureter graft in a renal transplant recipient: a case report. Transplant Proc 2014; 46:616-9. [PMID: 24656027 DOI: 10.1016/j.transproceed.2013.09.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/20/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Urothelial carcinomas of ureter grafts in renal transplant patients are rare. Here we report our experience with a case of BK virus-associated urothelial carcinoma in a ureter graft. CASE REPORT A 47-year-old man developed chronic renal failure secondary to diabetes mellitus and started maintenance hemodialysis in September 2007. Two months later, the patient received a renal transplant from his 70-year-old mother. The patient developed BK virus-associated nephropathy 1 year after transplantation and presented with a decline in renal function and hydronephrosis in the transplanted kidney 4 years 6 months after transplantation. Cystoscopy and retrograde pyelography revealed an irregular filling defect in the ureter graft. Cytologic diagnosis of his urine revealed a high-grade urothelial carcinoma. Computerized tomography showed a cT2 ureteral tumor and no involvement of other organs. The patient subsequently underwent a transplant nephroureterectomy with bladder cuff resection. Histopathologic findings revealed a high-grade urothelial carcinoma, pT2, in the ureter graft with SV40-positive staining. The patient was closely observed without adjuvant chemotherapy therapy and remained disease free 1 year after surgery. Renal transplant recipients with BK virus infection are at high risk of developing urologic malignancies. Close attention is necessary to diagnose post-transplantation urologica malignancies as early as possible.
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Upper tract urothelial carcinomas in patients with chronic kidney disease: relationship with diagnostic challenge. BIOMED RESEARCH INTERNATIONAL 2014; 2014:989458. [PMID: 25177705 PMCID: PMC4142288 DOI: 10.1155/2014/989458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/20/2014] [Accepted: 07/23/2014] [Indexed: 01/07/2023]
Abstract
Chronic kidney disease and upper tract urothelial carcinomas display a bidirectional relationship. Review of the literature indicates that early diagnosis and correct localization of upper tract urothelial carcinomas in dialysis patients and kidney transplant recipients are important but problematic. Urine cytology and cystoscopy have limited sensitivity for the diagnosis of upper tract urothelial carcinomas in dialysis patients. Enhanced computed tomography and magnetic resonance imaging could prove useful for the detection and staging of upper tract urothelial carcinomas in dialysis patients. Renal ultrasound can detect hydronephrosis caused by upper tract urothelial carcinomas in kidney transplant recipients but cannot visualize the carcinomas themselves. High detection rates for upper tract urothelial carcinomas in kidney transplant recipients have recently been demonstrated using computed tomography urography, which appears to be a promising tool. To detect carcinomas in dialysis patients and kidney transplant recipients as early as possible, regular screening in asymptomatic patients and diagnostic work-up in symptomatic patients should be performed using a combination of urological and imaging methods. Careful assessment of subsequent recurrence within the contralateral upper urinary tract and the urinary bladder is necessary for dialysis patients and kidney transplant recipients with upper tract urothelial carcinomas.
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Iodine-125 prostate seed brachytherapy in renal transplant recipients: an analysis of oncological outcomes and toxicity profile. J Contemp Brachytherapy 2014; 6:15-20. [PMID: 24790617 PMCID: PMC4003425 DOI: 10.5114/jcb.2014.40769] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 01/17/2014] [Accepted: 03/28/2014] [Indexed: 12/25/2022] Open
Abstract
Purpose Prostate cancer is among the most common non-cutaneous neoplasms affecting renal transplant recipients (RTRs). Available treatments including radical prostatectomy and external beam radiotherapy carry a risk of damage to the transplanted kidney, ureters, or bladder. We assessed the safety and efficacy of Iodine-125 (125I) prostate seed brachytherapy as an alternative to surgery and radiotherapy in these individuals. Material and methods We retrospectively reviewed our brachytherapy database to identify patients with a prior history of renal transplantation, who had undergone seed implantation for localized prostate cancer. Long term PSA control and treatment related toxicity, including graft dysfunction, urinary, rectal, and sexual complications, were assessed and compared with published outcomes for surgery and external beam radiotherapy. Results Of 1054 patients treated with permanent seed implantation from 2002-2012, we identified four who had a prior history of renal transplantation. Mean time from renal transplantation to prostate cancer diagnosis was 13 years. Mean follow-up after seed implantation was 44 months (range 12-60 months). All four patients remain free of PSA progression. No peri-operative complications were experienced following seed implantation, and all four patients continued to have normal graft function. Long term urinary and rectal function scores were comparable to reported outcomes for seed brachytherapy in the non-transplant population. Conclusions 125I prostate seed brachytherapy is associated with high rates of biochemical control and minimal toxicity to the renal graft in RTRs. This treatment should be considered as an alternative to surgery in managing RTRs with localized prostate cancer.
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Distinguishing characteristics of urothelial carcinoma in kidney transplant recipients between China and Western countries. Transplant Proc 2013; 45:2197-202. [PMID: 23747184 DOI: 10.1016/j.transproceed.2012.10.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/09/2012] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To identify significant distinctive characteristics of urothelial carcinoma (UC) in kidney transplant recipients between China and Western countries and investigate probable tumor screening and treatment factors contributing to these differences. METHODS Renal transplant recipients from 1998 to 2011 in our institution diagnosed with UC were included in this study. Our data on tumor incidence, clinical characteristics, and outcomes were compared with literature reports. RESULTS Among 2572 renal transplant recipients identified, 24 (0.93%) experienced UC, including 10 men and 14 women of overall mean age of 49.3 ± 11.6 years at transplantation and 53.5 ± 9.5 years at tumor detection. The Chinese traditional herbal intake mainly focused on 2 preparations: Aristolochic acid and rhubarb (the latter was mainly used in patients with chronic renal impairment) in 20 people. There were 21 (87.5%) cases of upper (UTUC) 5 cases of bilateral, and 13 cases of multifocal urinary tract urothelial carcinoma. Four subjects died owing to tumor progression at 4-63 months postoperatively. CONCLUSIONS UC in renal transplant recipients shared notable characteristics in China with widespread herb intake: UTUC predominance; multifocal and bilateral organ involvement; high rates of recurrence, progression, and dissemination, in contrast with bladder tumor dominance in Western countries. As a consequence, we suggest that bilateral nephroureterectomy should be performed prophylactically in high-risk patients, especially those with a long history of Chinese herb intake. The relationship of rhubarb consumption to UC in renal transplant recipients should be noted and evaluated.
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Prabharasuth D, Moses KA, Bernstein M, Dalbagni G, Herr HW. Management of Bladder Cancer After Renal Transplantation. Urology 2013; 81:813-9. [DOI: 10.1016/j.urology.2012.11.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 10/28/2012] [Accepted: 11/27/2012] [Indexed: 01/20/2023]
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Swietek N, Waldert M, Susani M, Schatzl G, Klatte T. Intravesical bacillus Calmette-Guérin instillation therapy for non-muscle-invasive bladder cancer following solid organ transplantation. Wien Klin Wochenschr 2013; 125:189-95. [DOI: 10.1007/s00508-013-0343-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 02/25/2013] [Indexed: 01/20/2023]
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Renal tumors in solid organ recipients: Clinical and pathologic features. Urol Oncol 2013; 31:255-8. [DOI: 10.1016/j.urolonc.2010.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 11/05/2010] [Accepted: 11/16/2010] [Indexed: 01/20/2023]
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Viart L, Surga N, Collon S, Jaureguy M, Elalouf V, Tillou X. The high rate of de novo graft carcinomas in renal transplant recipients. Am J Nephrol 2013; 37:91-6. [PMID: 23363786 DOI: 10.1159/000346624] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 12/18/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND To investigate the incidence, the clinical characteristics and outcomes of renal graft carcinomas in the same renal transplant population. METHODS From April 1989 to April 2012, 1,037 consecutive renal transplantations were performed in our department. Data were collected prospectively in an extensively maintained database. For all recipients, monitoring consisted of clinical examination and an abdominopelvic CT scan or ultrasonography at least once a year. RESULTS After 1,037 renal transplantations, 48 men and 14 women (sex ratio 3:4) with a mean age of 54 years (25.1-78.9) were included for urological malignancies. Eight graft carcinomas were identified: 7 renal cell carcinomas (5 papillary carcinomas and 2 clear cell carcinomas of the renal graft) and 1 transitional cell carcinoma of the ureteral graft (incidence 0.78%). Nephron-sparing surgery was chosen for 5 patients with good outcomes. All graft renal cell carcinomas were classified as pT1a and the mean size of tumors was 28.4 mm (range 6-45). The 5-year specific survival rate was 100%. No recurrence was observed with a mean follow-up of 36.8 months (4.1-84.3). CONCLUSION Thus confirming an increased risk of de novo graft cancer, close monitoring of renal transplant recipients should be discussed with at least an abdominopelvic ultrasonography and PSA measurement once a year. Renal cell graft carcinomas seemed to be mostly small and of papillary type and low grade.
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Affiliation(s)
- Ludovic Viart
- Urology and Transplantation Department, University Hospital Amiens, Amiens, France
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Wu JT, Wan FC, Gao ZL, Wang JM, Yang DD. Transperitoneal laparoscopic nephroureterectomy for native upper tract urothelial carcinoma in renal transplant recipients. World J Urol 2012; 31:135-9. [PMID: 22527671 DOI: 10.1007/s00345-012-0865-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 03/28/2012] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To analyze the safety and clinical outcome of laparoscopic nephroureterectomy (LNUT) for native upper tract urothelial carcinoma (UC) in renal transplant (RT) recipients. METHODS We conducted a retrospective analysis of 956 RT recipients from January 2003 to December 2010 to evaluate the benefit of LNUT for patients who were diagnosed with de novo UC after renal transplantation. RESULTS Women predominated (10/11, 91 %) in the 11 patients with upper tract UC who underwent LNUT. Five patients underwent LNUT ipsilateral to the transplanted kidney, 4 patients underwent contralateral LNUT, and 2 patients underwent bilateral LNUT. Nine were operated with LNUT combining resection of bladder cuff, 2 with right ureteral cancer underwent open ureterectomy with bladder cuff due to severe adhesions attached to the lesion. The mean surgical duration was 184.2 min (105-305), the mean blood loss was 182.3 ml (20-500), and the mean hospitalization time was 6.7 days (5-9). The mean levels of preoperative and postoperative serum creatinine were 0.99 mg/dl (0.78-1.16) and 1.01 mg/dl (0.89-1.18), respectively. No intraoperative complications occurred. One patient died of multiple metastases at 13 months after LNUT. The mean follow-up of the remaining 10 patients after diagnosis was 21.7 months (3-48). Two patients had recurrent bladder cancer and underwent transurethral resection of the tumor. Eight patients showed no evidence of disease during the follow-up. CONCLUSIONS LNUT is a safe and effective approach with low morbidity in transplant recipients, and this therapy provides less trauma, quicker recovery, and acceptable oncological outcomes.
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Affiliation(s)
- Ji-Tao Wu
- Department of Urology, Yantai Yuhuangding Hospital, Yantai, 264000, Shandong Province, China
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Rigamonti N, Bellone M. Prostate cancer, tumor immunity and a renewed sense of optimism in immunotherapy. Cancer Immunol Immunother 2012; 61:453-68. [PMID: 22331081 PMCID: PMC11028924 DOI: 10.1007/s00262-012-1216-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 01/28/2012] [Indexed: 12/12/2022]
Abstract
The recent FDA approval of the first therapeutic vaccine against prostate cancer has revitalized the public interest in the fields of cancer immunology and immunotherapy. Yet, clinical results are modest. A reason for this limited success may reside in the capacity of the tumor to convert inflammation in a tumor-promoting condition and eventually escape immune surveillance. Here we present the main known interactions between the prostate tumor and the immune system, showing how the malignancy can dodge the immune system by also exerting several immunosuppressive mechanisms. We also discuss experimental and clinical strategies proposed to counteract cancer immune evasion and emphasize the importance of implementing appropriate murine models like the transgenic adenocarcinoma of the mouse prostate model for investigating the biology of prostate cancer and novel immunotherapy approaches against it.
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Affiliation(s)
- Nicolò Rigamonti
- Cellular Immunology Unit, Program of Immunology, Gene Therapy and Bio-Immunotherapy of Cancer (PIBIC), San Raffaele Scientific Institute, via Olgettina 58, 20132 Milan, Italy
| | - Matteo Bellone
- Cellular Immunology Unit, Program of Immunology, Gene Therapy and Bio-Immunotherapy of Cancer (PIBIC), San Raffaele Scientific Institute, via Olgettina 58, 20132 Milan, Italy
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Olivani A, Iaria M, Missale G, Capocasale E, Biasini E, Mazzoni MP, Lombardelli L, Luzi E, Frattini A, Pelosi G. Percutaneous ultrasound-guided radiofrequency ablation of an allograft renal cell carcinoma: a case report. Transplant Proc 2012; 43:3997-9. [PMID: 22172886 DOI: 10.1016/j.transproceed.2011.08.089] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 08/29/2011] [Indexed: 12/29/2022]
Abstract
BACKGROUND Renal cell carcinomas (RCCs) are rarely described in transplanted kidneys. Available therapeutic strategies range from allograft nephrectomy to nephron-sparing procedures such as partial nephrectomy or image-guided thermal ablation. Percutaneous radiofrequency ablation (RFA) is a minimally invasive technique which provides promising oncologic outcomes in small allograft RCCs while preserving allograft function. So far, only a few cases have been reported in the transplant setting. We describe a renal transplant RCC successfully approached by ultrasound-guided RFA. METHODS A 42-year-old renal transplant recipient developed a small subcapsular allograft RCC at 11 years after transplantation. The decline in glomerular filtration rare prompted us to preserve as much parenchyma as possible. Ultrasound-guided RFA was performed under light sedation and local analgesia in a single session with a Starbust Talon needle. RESULTS Postablation contrast-enhanced ultrasound displayed a 25×23 mm avascular area of complete necrosis. After 3 months gadolinium-enhanced magnetic resonance imaging confirmed the absence of viable tumor tissue and while the patient did not experience any graft function reduction (serum creatinine 2.6 mg/dL). CONCLUSIONS Image-guided RFA represents a promising therapeutic modality for small allograft RCCs in recipients with mild graft dysfunction and/or elevated surgical risk. It is associated with low morbidity and parenchymal preservation.
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Affiliation(s)
- A Olivani
- Division of Infectious Diseases and Hepatology, Parma University Hospital, Parma, Italy
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Rogers A, Koo Ng J, Glendinning J, Rix D. The management of transitional cell carcinoma (TCC) in a European regional renal transplant population. BJU Int 2012; 110:E34-40. [DOI: 10.1111/j.1464-410x.2011.10777.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Manassero F, Di Paola G, Mogorovich A, Giannarini G, Boggi U, Selli C. Orthotopic bladder substitute in renal transplant recipients: experience with Studer technique and literature review. Transpl Int 2011; 24:943-8. [PMID: 21722198 DOI: 10.1111/j.1432-2277.2011.01292.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Renal transplant recipients with high-risk bladder cancer following cystectomy need a urinary diversion preserving the renal function and possibly maintaining body image, while still offering the best oncological outcome. The aim of this report is to describe our experience of radical cystectomy and orthotopic ileal neobladder with Studer technique in this population, and to review the literature. We performed radical cystectomy and Studer ileal neobladder in four male patients (median age 67 years) after median time of 9.5 years following renal transplantation. Pathology revealed pT1HGN+ transitional cell carcinoma in one case, pT1HGN0 in two and pT3aHGN0 in one. Two patients presenting aggressive disease (N+ and pT3a) died of tumour progression after 20 and 14 months, respectively, while the other two are alive after 56 and 36 months of follow-up with no evidence of disease, stable serum creatinine (2.29 and 1.6 mg/dl) and mild metabolic acidosis. Day and night-time urinary continence were satisfactory in all patients. Good functional outcomes have been reported in the 20 cases of ileal orthotopic neobladder with different techniques published so far and the global experience of 24 cases with a median follow-up of 39 months documents a cancer specific survival of 62.5%.
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Affiliation(s)
- Francesca Manassero
- Department of Urology, University of Pisa, Nuovo Ospedale Santa Chiara, Presidio di Cisanello, via Paradisa 2, Pisa, Italy.
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