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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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Diller R, Senninger N. Treatment options and outcome for renal cell tumors in the transplanted kidney. Int J Artif Organs 2009; 31:867-74. [PMID: 19009504 DOI: 10.1177/039139880803101002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The diagnosis of renal cell carcinoma in a transplanted kidney is rare but with possibly devastating consequences. In addition to transplant nephrectomy, which inevitably results in a return to dialysis, various treatment options such as different techniques for nephron sparing surgery and local ablative procedures (like radiofrequency ablation or cryoablation) have been described in the literature. An important issue is to find the balance between the preservation of the transplant function, on the one hand, which is dependent on the maintenance of an immunosuppressive regimen, and a sufficiently radical tumor therapy on the other hand. To provide an overview of current therapeutic attempts to cure transplant renal cell carcinoma under these conditions, published data on related therapies and outcomes are summarized.
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Affiliation(s)
- R Diller
- Department of General Surgery, University Hospital of Münster, Münster - Germany.
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Whitson JM, Stackhouse GB, Freise CE, Meng MV, Stoller ML. Laparoscopic nephrectomy, ex vivo partial nephrectomy followed by allograft renal transplantation. Urology 2008; 70:1007.e1-3. [PMID: 18068465 DOI: 10.1016/j.urology.2007.07.070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2007] [Revised: 06/12/2007] [Accepted: 07/19/2007] [Indexed: 01/20/2023]
Abstract
A shortage of available kidneys exists. Forty percent of patients with end stage renal disease wait more than 2 years for renal transplant. We report a case of a 22-year-old man who underwent laparoscopic radical nephrectomy for a 2-cm central renal mass. Ex vivo partial nephrectomy and renorraphy were performed. The reconstructed kidney was allotransplanted to a 62-year-old man with end stage renal disease. The recipient has excellent graft function. Imaging shows no evidence of recurrence or metastasis at 2 years' follow-up. Incidence and management of de novo renal cell carcinoma in renal allografts are reviewed.
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Affiliation(s)
- Jared M Whitson
- Department of Urology, University of California, San Francisco, San Francisco, California 94143, USA.
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Thakar CV, Lara A, Goel M, Nally JV. Staghorn calculus in renal allograft presenting as acute renal failure. ACTA ACUST UNITED AC 2003; 31:414-6. [PMID: 14508619 DOI: 10.1007/s00240-003-0364-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2003] [Accepted: 08/05/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Urolithiasis is a rare complication in renal transplant recipients. We report a case of a staghorn calculus occurring in renal allograft, presenting as anuric renal failure with Gram-negative sepsis. METHODS AND RESULTS A 48-year-old Caucasian female, with end-stage renal disease due to autosomal dominant polycystic kidney disease, underwent cadaveric renal transplantation in 1986. Sixteen years after transplant, she presented with Gram-negative sepsis with Proteus mirabilis and acute anuric renal failure in the allograft. After undergoing an emergency nephrostomy and treatment of sepsis, a staghorn calculus was subsequently removed by percutaneous nephrolithotomy. Based on the stone analysis and history of urinary tract infections with urease splitting bacteria, the calculus was thought to be infection-induced. CONCLUSION Although a rare complication, urolithiasis in an allograft can be associated with significant morbidity. Immediate recognition is critical to restore renal allograft function and to treat associated serious infection in an immunocompromised patient.
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Affiliation(s)
- Charuhas V Thakar
- Department of Nephrology and Hypertension, The Cleveland Clinic Foundation, Desk A-51, 9500 Euclid Avenue, Cleveland OH 44195, USA.
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Carver BS, Zibari GB, McBride V, Venable DD, Eastham JA. The incidence and implications of renal cell carcinoma in cadaveric renal transplants at the time of organ recovery. Transplantation 1999; 67:1438-40. [PMID: 10385082 DOI: 10.1097/00007890-199906150-00008] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND With the exception of primary central nervous system tumors, organ recovery is no longer considered from donors with known malignancy. Because intrathoracic and intraabdominal organs are usually recovered before the kidneys, we examined the incidence of renal cell carcinoma in cadaveric donor kidneys at the time of organ recovery. This would establish the theoretical risk of transplanting donor organs from a patient with a known renal malignancy. METHODS In cooperation with the Louisiana Organ Procurement Agency, we reviewed the records of all patients who were cadaveric kidney donors in the state of Louisiana between September 1991 and October 1997. Information was reviewed and analyzed on donor age, sex, race, past medical/surgical history, cause of death, and the findings at the time of organ recovery. RESULTS A total of 553 consecutive cadaveric donors were identified, with 1106 kidneys recovered. Of the 553 cadaveric donors, 5 (0.9%) were noted to have an incidental renal cell carcinoma. All tumors were identified in separate donors; that is, none of the tumors were bilateral. None of the five donors had documented symptoms referable to their urinary tract. All tumors were either T1 or T2 by the tumor, node, metastasis classification system, and no evidence of nodal or distant metastatic disease was present. In one case, the contralateral kidney, heart, and liver were transplanted before the tumor was identified. In the remaining four cases, all organs (renal and nonrenal) were discarded. CONCLUSIONS Renal cell carcinoma is rarely found during renal recovery from a cadaveric donor. However, because the kidneys are usually recovered after the intrathoracic and intraabdominal organs, careful palpation of the kidneys and exploration of any abnormalities is mandated to avoid transplanting any organs from a donor with a known renal malignancy.
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Affiliation(s)
- B S Carver
- Department of Urology, Louisiana State University Medical Center, Shreveport 71130, USA
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Bissada NK, Bissada SA, Fitts CT, Rajagopalan PR, Nelson R. Renal transplantation from living related donor after excision of angiomyolipoma of the donor kidney. J Urol 1993; 150:174-5. [PMID: 8510244 DOI: 10.1016/s0022-5347(17)35427-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A 44-year-old woman with end stage renal disease underwent living related renal transplantation after planned partial nephrectomy of the donor kidney for angiomyolipoma.
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Affiliation(s)
- N K Bissada
- Department of Urology, Medical University of South Carolina, Charleston
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Abstract
A cadaver kidney, reported to contain a "simple cyst," was received from another institution. Frozen section biopsy prior to transplant showed renal cell carcinoma. The contralateral kidney already had been transplanted at the other medical facility.
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Affiliation(s)
- M J Pliskin
- Department of Surgery, Walter Reed Army Medical Center, Washington, DC
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