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Correia J, Teixeira B, Mendes G, Fraga A, Silva-Ramos M. Renal cell carcinoma in native kidneys before transplantation - When will we stop waiting? Arch Ital Urol Androl 2023; 95:11240. [PMID: 36924364 DOI: 10.4081/aiua.2023.11240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/17/2023] [Indexed: 03/17/2023] Open
Abstract
INTRODUCTION Kidney transplantation requires immunosuppression, traditionally regarded as a risk factor for progression in all malignancies. Based on the Cincinnati Registry, a waiting period before transplantation is therefore mandatory. However, recent evidence suggests this increased risk is restricted to particular tumors, whereas others like renal cell carcinoma (RCC) are not negatively affected. We aimed to compare oncological outcomes of RCC in native kidneys of end-stage renal disease (ESRD) patients, according to their transplantation or dialysis status. MATERIAL AND METHODS Retrospective analysis of all ESRD patients diagnosed with RCC between 2010 and 2020 in our center. Recurrence-free survival (RFS) and overall survival (OS) were estimated with Kaplan-Meier curves. Multivariable Cox regression model was used to evaluate their association with kidney transplantation. RESULTS Clinical and pathological characteristics were similar between groups. Kidney transplant recipients had similar risk of recurrence (hazard ratio [HR] 0.40, 95% confidence interval [CI) 0.04-4.46, p = 0.458) and overall survival (HR 0.34, 95%CI 0.07-1.77, p = 0.202) as dialyzed patients. On multivariable Cox regression model, presence or absence of transplantation was not significantly associated with RFS (p = 0.479) or OS (p = 0.236). Time on dialysis was the only independent predictor of worse survival (HR 1.86, 95%CI 1.18-2.93, p = 0.008). CONCLUSIONS Most RCC in native kidneys of ESRD patients are low-grade, low-stage and exhibit favourable pathological and outcome features. Immunosuppression does not seem to have an impact on oncological outcomes, but an increased time on dialysis seems to be associated with worse overall survival. Therefore, waiting time for transplantation for these tumors could be reduced.
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Affiliation(s)
- Jorge Correia
- Department of Urology, Centro Hospitalar Universitário do Porto.
| | | | - Gonçalo Mendes
- Department of Urology, Centro Hospitalar Universitário do Porto.
| | - Avelino Fraga
- Department of Urology, Centro Hospitalar Universitário do Porto.
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2
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Durakbaşa ÇU, Ugurlu D, Bozbeyoglu SG, Aydoner S, Seneldir H, Candir MO, Candan C, Gemici A. Bilateral Native Kidney Papillary Renal Cell Carcinomas in a 11-Year-Old Renal Transplant Patient. European J Pediatr Surg Rep 2022; 10:e160-e163. [PMCID: PMC9719804 DOI: 10.1055/s-0042-1759546] [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: 05/22/2022] [Accepted: 10/04/2022] [Indexed: 12/07/2022] Open
Abstract
Renal cell carcinomas (RCCs) are the most common renal tumors in adults and are usually sporadic and unilateral. Renal transplant recipients have an increased risk of developing RCC. RCC development after kidney transplantation is very rarely reported in children. We present a 11-year-old boy who had cadaveric kidney transplantation for kidney failure 2 years ago. He was under immunosuppressive therapy and presented with microscopic hematuria. An ultrasound (US) revealed bilateral solid renal masses. Further cross-sectional imaging showed a 60 × 70 × 60-mm right renal mass with claw sign and a 5 × 6 × 6-mm mass in the left renal lower pole. A bilateral radical nephroureterectomy of native kidneys was performed. The pathology revealed bilateral papillary RCC without TFE3 upregulation. The patient was kept on low-dose immunosuppressive therapy in the perioperative period. He received no chemotherapy but a close radiological surveillance was undertaken. He is tumor-free 2 years after the operation. RCC is a rare tumor for children and bilateralism is even rarer. The child had a history of chronic kidney disease, peritoneal dialysis, and immunosuppressive therapy. As there are no standardized protocols regarding imaging in transplanted kidneys routine surveillance, US follow-up should also focus on detecting malignancy.
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Affiliation(s)
- Çiğdem Ulukaya Durakbaşa
- Department of Pediatric Surgery, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey,Department of Pediatric Surgery, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey,Address for correspondence Prof. Çiğdem Ulukaya Durakbaşa, MD Department of Pediatric Surgery, Istanbul Medeniyet University Faculty of MedicineKadikoy, Istanbul 34000Turkey
| | - Deniz Ugurlu
- Department of Pediatric Surgery, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | | | - Sinem Aydoner
- Department of Pediatric Surgery, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Hatice Seneldir
- Department of Pathology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Onur Candir
- Department of Pediatric Oncology, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Cengiz Candan
- Department of Pediatric Nephrology, Istanbul Medeniyet University Faculty of Medicine, Uskudar, Istanbul, Turkey
| | - Atilla Gemici
- Department of Pediatric Nephrology, Baskent University Istanbul Hospital, Istanbul, Turkey
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3
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Manasa T, Meyyappan V, Sandeep P, Mylarappa P, Ramesh D, Jayakumar V, Penmetsa GK. Incidence, management and treatment outcomes of renal malignancy in a post-transplant recipient at a tertiary care centre: A 16-year experience. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221081814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction and Objective: Although the incidence of malignancy in renal transplant recipients is on the rise owing to boom in the post-transplant immunosuppressive therapy, there is paucity of literature regarding their reporting and management. In this study, we report the incidence of de novo renal malignancies, post-renal transplantation at our centre over a 16-year period and discuss their management. Methods: All patients who underwent renal transplantation at our department between March 2004 and February 2020 were included and retrospectively reviewed. We analysed the incidence of renal malignancy both in the native kidney and the graft, histological subtype, time to and type of treatment. Results: A total of 376 patients underwent renal transplantation. Mean age of recipients was 48.2 and 52.15 years among those who developed cancer. 13 (2.93%) of 376 recipients developed urogenital malignancy, of whom 8 had renal cell carcinoma (RCC) in their native kidneys and 1 in the allograft. Transitional cell carcinoma (TCC) of renal pelvis was noted in three patients with one concomitant TCC of bladder. No treatment-related graft losses occurred in the native kidney malignancy. Patients with RCC underwent nephrectomy while TCC of renal pelvis underwent nephroureterectomy with bladder cuff excision. Transurethral resection was done for bladder tumour. All patients were followed up as per standard protocol. Conclusion: A rise in urological post-transplant malignancies mandates regular surveillance after renal transplantation to ensure early detection of de novo malignancies and early initiation of treatment. Goal should be to minimise adverse graft outcomes with no compromise on oncological outcomes. Level of evidence: Not applicable
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Affiliation(s)
- T Manasa
- Department of Urology, Ramaiah Medical College, India
| | | | | | | | - D Ramesh
- Department of Urology, Ramaiah Medical College, India
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Lopes RP, Junior JER, Taromaru E, Campagnari JC, Araújo MRT, Abensur H. Wünderlich Syndrome in Renal Transplant Recipients: A Case Report and Literature Review. Transplant Proc 2021; 53:2517-2520. [PMID: 34556342 DOI: 10.1016/j.transproceed.2021.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Wünderlich syndrome, or spontaneous atraumatic renal hemorrhage, is a clinical entity rarely described in the native kidney of patients who have undergone renal transplant. Although its manifestation is quite similar in reported cases, it may present few symptoms, from bleeding of unidentified etiology to dramatic pictures associated with hypovolemic shock. There are few reports of spontaneous hemorrhage of a native kidney after kidney transplantation. CASE REPORT We present a 38-year-old male patient who developed hemorrhage of a ruptured native kidney after a late renal transplantation. We analyze what has been reported in the literature and highlight the possibility of this complication after kidney transplantation. Imaging exams and surgical specimen demonstrated the presence of ruptured angiomyolipoma in the patient's native right kidney. The postoperative period was not complicated, with a benign clinical evolution. CONCLUSION Although rare in patients who have undergone renal transplant, it is justified to suggest Wünderlich syndrome in the presence of acute flank pain, abdominal tenderness, and signs of internal bleeding (Lenk's triad), with unexplained hemoglobin drop.
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Affiliation(s)
- Rolf Passos Lopes
- Clínica de Nefrologia e Transplantes, Hospital BP - Beneficência Portuguesa, São Paulo, Brazil.
| | | | - Eduardo Taromaru
- Clínica de Nefrologia e Transplantes, Hospital BP - Beneficência Portuguesa, São Paulo, Brazil
| | - João Carlos Campagnari
- Clínica de Nefrologia e Transplantes, Hospital BP - Beneficência Portuguesa, São Paulo, Brazil
| | | | - Hugo Abensur
- Clínica de Nefrologia e Transplantes, Hospital BP - Beneficência Portuguesa, São Paulo, Brazil
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5
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Sultan S, Finn C, Craig-Schapiro R, Aull M, Watkins A, Kapur S, Del Pizzo J. Simultaneous Living Donor Kidney Transplant and Laparoscopic Native Nephrectomy: An Approach to Kidney Transplant Candidates with Suspected Renal-Cell Carcinoma. J Endourol 2020; 35:1001-1005. [PMID: 33238756 DOI: 10.1089/end.2020.0841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Kidney transplant candidates are occasionally found during the pre-transplant evaluation to have a suspicious mass in a native kidney. Further work-up and management of such a mass may delay transplantation for several months, which may create logistic barriers to transplant, particularly if there are timing constraints of the donor. In this study, we report our experience with simultaneous living donor kidney transplant and laparoscopic native nephrectomy, where the indication for nephrectomy was a suspicious lesion. Methods: We performed a retrospective review of patients who underwent simultaneous kidney transplant and native nephrectomy using prospectively collected data. We analyzed relevant patient characteristics, surgical details, pathologic results, and long-term follow-up. Results: We identified 16 patients who underwent simultaneous living donor kidney transplantation and laparoscopic native nephrectomy at our institution between 2013 and 2018. Ten (62.5%) patients were found to have renal-cell carcinoma (RCC) on the final pathology. No patients had recurrent RCC, at a median follow-up of 4 years. Conclusion: For patients who are planning to undergo a living donor kidney transplant and are found to have a small mass that is suspicious for RCC, a simultaneous living donor kidney transplant and laparoscopic native nephrectomy is a possible approach in selected patients.
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Affiliation(s)
- Samuel Sultan
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Caitlin Finn
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Rebecca Craig-Schapiro
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Meredith Aull
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Anthony Watkins
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Sandip Kapur
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Joseph Del Pizzo
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
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6
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Nabavizadeh R, Noorali AA, Makhani SS, Hong G, Holzman S, Patil DH, Kim FY, Tso PL, Turgeon NA, Ogan K, Master VA. Transplant Radical Nephrectomy and Transplant Radical Nephroureterectomy for Renal Cancer: Postoperative and Survival Outcomes. Ann Transplant 2020; 25:e925865. [PMID: 33093437 PMCID: PMC7590527 DOI: 10.12659/aot.925865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The treatment of complex tumors in non-functioning renal transplants requiring surgical extirpation is challenging. Here, we report the largest series of patients who underwent transplant radical nephrectomy for renal cell carcinoma (RCC) and transplant radical nephroureterectomy for urothelial cell carcinoma (UCC) in their transplanted kidneys. MATERIAL AND METHODS From 2004 to 2018, 10 patients underwent transplant radical nephrectomy (7 patients) and nephroureterectomy (3 patients). Retrospective analyses, in terms of complications, oncological recurrence, and survival, of peri-operative and long-term outcomes, were performed. RESULTS Out of the 10 patients, 7 had RCC and 3 had UCC. No intraoperative mortality occurred. Three patients presented with Clavien-Dindo grade IIIa or greater within 30 days of surgery. Two patients died within 60 days of surgery, both due to vascular events: one due to myocardial infarction and one due to stroke. Two other patients died: one after 2.9 years, due to myocardial infarction, and the other after 6 years, due to unknown reasons. At the 7-year follow-up, there was a 60% overall survival rate. For all patients, average survival post-nephrectomy was approximately 4.5 years, including the 6 living patients and 4 deceased patients. Importantly, there was no observed cancer recurrence. CONCLUSIONS This study reports outcomes of the largest series of transplant radical nephrectomy and nephroureterectomy for malignancies of renal allografts. In the optimized setting, extirpative surgeries appear safe, with favorable long-term oncological and survival outcomes.
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Affiliation(s)
- Reza Nabavizadeh
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Gordon Hong
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Sarah Holzman
- Department of Urology, University of California Irvine and Children's Hospital, Orange, CA, USA
| | - Dattatraya H Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Frances Y Kim
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Paul L Tso
- Department of Transplant Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Nicole A Turgeon
- Department of Transplant Surgery, University of Texas Dell Medical School, Austin, TX, USA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA
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7
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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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8
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Incidence and Mortality of Renal Cell Carcinoma after Kidney Transplantation: A Meta-Analysis. J Clin Med 2019; 8:jcm8040530. [PMID: 30999706 PMCID: PMC6517974 DOI: 10.3390/jcm8040530] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background: The incidence and mortality of renal cell carcinoma (RCC) after kidney transplantation (KTx) remain unclear. This study’s aims were (1) to investigate the pooled incidence/incidence trends, and (2) to assess the mortality/mortality trends in KTx patients with RCC. Methods: A literature search was conducted using the MEDLINE, EMBASE and Cochrane databases from inception through October 2018. Studies that reported the incidence or mortality of RCC among kidney transplant recipients were included. The pooled incidence and 95% CI were calculated using a random-effect model. The protocol for this meta-analysis is registered with PROSPERO; no. CRD42018108994. Results: A total of 22 observational studies with a total of 320,190 KTx patients were enrolled. Overall, the pooled estimated incidence of RCC after KTx was 0.7% (95% CI: 0.5–0.8%, I2 = 93%). While the pooled estimated incidence of de novo RCC in the native kidney was 0.7% (95% CI: 0.6–0.9%, I2 = 88%), the pooled estimated incidence of RCC in the allograft kidney was 0.2% (95% CI: 0.1–0.4%, I2 = 64%). The pooled estimated mortality rate in KTx recipients with RCC was 15.0% (95% CI: 7.4–28.1%, I2 = 80%) at a mean follow-up time of 42 months after RCC diagnosis. While meta-regression analysis showed a significant negative correlation between year of study and incidence of de novo RCC post-KTx (slopes = −0.05, p = 0.01), there were no significant correlations between the year of study and mortality of patients with RCC (p = 0.50). Egger’s regression asymmetry test was performed and showed no publication bias in all analyses. Conclusions: The overall estimated incidence of RCC after KTX was 0.7%. Although there has been a potential decrease in the incidence of RCC post-KTx, mortality in KTx patients with RCC has not decreased over time.
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9
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Kleine-Döpke D, Oelke M, Schwarz A, Schwager Y, Lehner F, Klempnauer J, Schrem H. Renal cell cancer after kidney transplantation. Langenbecks Arch Surg 2018; 403:631-641. [DOI: 10.1007/s00423-018-1694-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/06/2018] [Indexed: 01/20/2023]
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10
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Tan AL, Lawson M, Preston J, Wood S, Griffin A, Rhee H. Case Report: Spontaneous Hemorrhage of a Rare Renal Tumor in the Native Kidney of a Renal Transplant Recipient. Transplant Proc 2018; 50:902-904. [PMID: 29555245 DOI: 10.1016/j.transproceed.2017.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/11/2017] [Indexed: 01/20/2023]
Abstract
Renal cancers are some of the most common solid organ malignancies found during follow-up of patients who have undergone renal transplantation (RT). In this case report, we describe a life-threatening spontaneous hemorrhage of a rare subtype of renal cell carcinoma in the native kidney of a 27-year-old man, 4 years after RT. After fluid resuscitation and stabilization, the patient underwent emergent open radical nephrectomy with the final histopathology reporting T1bN0Mx mucinous tubular and spindle cell (MTSC) carcinoma. This case report highlights the need to consider an underlying malignancy in patients who presents with spontaneous hemorrhage of native kidneys after RT.
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Affiliation(s)
- A L Tan
- Queensland Renal Transplant Services, Princess Alexandra Hospital, Woolloongabba QLD, Australia
| | - M Lawson
- Queensland Renal Transplant Services, Princess Alexandra Hospital, Woolloongabba QLD, Australia; Department of Urology, Princess Alexandra Hospital, Woolloongabba QLD, Australia
| | - J Preston
- Queensland Renal Transplant Services, Princess Alexandra Hospital, Woolloongabba QLD, Australia; Department of Urology, Princess Alexandra Hospital, Woolloongabba QLD, Australia
| | - S Wood
- Queensland Renal Transplant Services, Princess Alexandra Hospital, Woolloongabba QLD, Australia; Department of Urology, Princess Alexandra Hospital, Woolloongabba QLD, Australia
| | - A Griffin
- Queensland Renal Transplant Services, Princess Alexandra Hospital, Woolloongabba QLD, Australia
| | - H Rhee
- Queensland Renal Transplant Services, Princess Alexandra Hospital, Woolloongabba QLD, Australia; Department of Urology, Princess Alexandra Hospital, Woolloongabba QLD, Australia.
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11
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Hickman LA, Sawinski D, Guzzo T, Locke JE. Urologic malignancies in kidney transplantation. Am J Transplant 2018; 18:13-22. [PMID: 28985026 DOI: 10.1111/ajt.14533] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 09/22/2017] [Accepted: 09/26/2017] [Indexed: 01/25/2023]
Abstract
With advances in immunosuppression, graft and patient outcomes after kidney transplantation have improved considerably. As a result, long-term complications of transplantation, such as urologic malignancies, have become increasingly important. Kidney transplant recipients, for example, have a 7-fold risk of renal cell carcinoma (RCC) and 3-fold risk of urothelial carcinoma (UC) compared with the general population. While extrapolation of data from the general population suggest that routine cancer screening in transplant recipients would allow for earlier diagnosis and management of these potentially lethal malignancies, currently there is no consensus for posttransplantation RCC or UC screening as supporting data are limited. Further understanding of risk factors, presentation, optimal management of, and screening for urologic malignancies in kidney transplant patients is warranted, and as such, this review will focus on the incidence, surveillance, and treatment of urologic malignancies in kidney transplant recipients.
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Affiliation(s)
- Laura A Hickman
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Deirdre Sawinski
- Department of Medicine, Renal Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thomas Guzzo
- Department of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jayme E Locke
- Department of Surgery, Division of Transplantation, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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12
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Hebert SA, Swinford RD, Hall DR, Au JK, Bynon JS. Special Considerations in Pediatric Kidney Transplantation. Adv Chronic Kidney Dis 2017; 24:398-404. [PMID: 29229171 DOI: 10.1053/j.ackd.2017.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Universally accepted as the treatment of choice for children needing renal replacement therapy, kidney transplantation affords children the opportunity for an improved quality of life over dialysis therapy. Immunologic and surgical advances over the last 15 years have improved the pediatric patient and kidney graft survival. Unique to pediatrics, congenital genitourinary anomalies are the most common primary diseases leading to kidney failure, many with urological issues. Early urological evaluation for post-transplant bladder dysfunction and emphasis on immunization adherence are the mainstays of pediatric pretransplant and post-transplant evaluations. A child's height can be challenging, sometimes requiring an intra-abdominally placed graft, particularly if the patient is <20 kg. Maintenance immunosuppression regimens are similar to adult kidney graft recipients, although distinctive pharmacokinetics may change dosing intervals in children from twice a day to thrice a day. Viral infections and secondary malignancies are problematic for children relative to adults. Current trends to reduce/remove corticosteroid therapy from post-transplant protocols have produced improved linear growth with less steroid toxicity; although these studies are still ongoing, graft function and survival are considered acceptable. Finally, all children with a kidney transplant need a smooth transition to adult clinics. Future research in pertinent psychosocial aspects and continued technological advances will only serve to optimize the transition process. Although some aspects of kidney transplantation are similar in children and adults, for instance immunosuppression and immunosuppressive regimens, and rejection mechanisms and their diagnosis using the Banff criteria, there are important differences this review will focus on and which continue to drive innovation.
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13
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Trends in management of the small renal mass in renal transplant recipient candidates: A multi-institutional survey analysis. Urol Oncol 2017; 35:529.e17-529.e22. [DOI: 10.1016/j.urolonc.2017.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 02/15/2017] [Accepted: 03/09/2017] [Indexed: 11/20/2022]
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14
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Bieniasz M, Chmura A, Kwapisz M, Czerwińska M, Kieszek R, Domagała P, Wszoła M, Serwańska-Świętek M, Górnicka B, Durlik M, Pączek L, Kwiatkowski A. Renal Tumor in Allogeneic Kidney Transplant Recipient. Transplant Proc 2017; 48:1849-54. [PMID: 27496506 DOI: 10.1016/j.transproceed.2016.01.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/21/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Malignancies will be a leading cause of mortality in renal transplant recipients in the next 20 years. Renal cell cancer (RCC) is the most common urologic cancer in kidney transplant recipients. The risk of RCC development in kidney transplant recipients is 15-100 times higher than in the general population. The purpose of the current retrospective study was to assess the frequency of nephrectomies performed because of renal tumors in the native kidneys in kidney transplant recipients in the Department of General and Transplantation Surgery at the Medical University of Warsaw between 2010 and 2014 year; the identification of kidney recipients diagnosed with RCC; and epidemiologic, clinical, and histopathological aspects associated with RCC. PATIENTS AND METHODS A total of 319 nephrectomies were performed in the Department of General and Transplantation Surgery at the Medical University of Warsaw between 2010 and 2014 year. Renal tumors were diagnosed in 25 renal transplant recipients. RESULTS Among malignant tumors, 13 cases of RCC and 1 case of post-transplant lymphoproliferative disorder (PTLD) were observed. There was no significant difference between age and duration of pretransplantation dialysis in patients with RCC and patients with benign tumors (P = .14 and P = .91, respectively). Body mass index was significantly higher in patients with RCC than in patients with benign tumors (P = .04). CONCLUSIONS Renal cell cancer is more common among male kidney recipients. There is a good Polish screening system allowing detection of kidney cancer in native kidney. We recommend performing periodic screening for kidney cancers to obtain an early diagnosis.
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Affiliation(s)
- M Bieniasz
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - A Chmura
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Kwapisz
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Czerwińska
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - R Kieszek
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - P Domagała
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Wszoła
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Serwańska-Świętek
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - B Górnicka
- Department of Pathology, Medical University of Warsaw, Warsaw, Poland
| | - M Durlik
- Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - L Pączek
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - A Kwiatkowski
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
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15
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Karami S, Yanik EL, Moore LE, Pfeiffer RM, Copeland G, Gonsalves L, Hernandez B, Lynch CF, Pawlish K, Engels EA. Risk of Renal Cell Carcinoma Among Kidney Transplant Recipients in the United States. Am J Transplant 2016; 16:3479-3489. [PMID: 27160653 PMCID: PMC5104677 DOI: 10.1111/ajt.13862] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/24/2016] [Accepted: 04/28/2016] [Indexed: 01/25/2023]
Abstract
Renal cell carcinoma (RCC) is a common malignancy following kidney transplantation. We describe RCC risk and examine RCC risk factors among US kidney recipients (1987-2010). The Transplant Cancer Match Study links the US transplant registry with 15 cancer registries. Standardized incidence ratios (SIRs) were used to compare RCC risk (overall and for clear cell [ccRCC] and papillary subtypes) to the general population. Associations with risk factors were assessed using Cox models. We identified 683 RCCs among 116 208 kidney recipients. RCC risk was substantially elevated compared with the general population (SIR 5.68, 95% confidence interval 5.27-6.13), especially for papillary RCC (SIR 13.3 versus 3.98 for ccRCC). Among kidney recipients, RCC risk was significantly elevated for blacks compared to whites (hazard ratio [HR] 1.50) and lower in females than males (HR 0.56). RCC risk increased with prolonged dialysis preceding transplantation (p-trend < 0.0001). Risk was variably associated for RCC subtypes with some medical conditions that were indications for transplantation: ccRCC risk was reduced with polycystic kidney disease (HR 0.54), and papillary RCC was increased with hypertensive nephrosclerosis (HR 2.02) and vascular diseases (HR 1.86). In conclusion, kidney recipients experience substantially elevated risk of RCC, especially for papillary RCC, and multiple factors contribute to these cancers.
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Affiliation(s)
- S. Karami
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - E. L. Yanik
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - L. E. Moore
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - R. M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - G. Copeland
- Michigan Cancer Surveillance Program, Michigan Department of Community Health, Lansing, Michigan, USA
| | - L. Gonsalves
- Connecticut Department of Public Health, Hartford, Connecticut, USA
| | - B.Y, Hernandez
- University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - C. F. Lynch
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - K. Pawlish
- New Jersey State Cancer Registry, Cancer Epidemiology Services, New Jersey Department of Health, Trenton, New Jersey, USA
| | - E. A. Engels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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Klein JA, Gonzalez SA, Fischbach BV, Yango AF, Rajagopal A, Rice KM, Saim M, Barri YM, Melton LB, Klintmalm GB, Chandrakantan A. Routine ultrasonography surveillance of native kidneys for renal cell carcinoma in kidney transplant candidates. Clin Transplant 2016; 30:946-53. [DOI: 10.1111/ctr.12769] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2016] [Indexed: 12/14/2022]
Affiliation(s)
| | | | | | | | | | - Kim M. Rice
- Baylor University Medical Center; Dallas TX USA
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17
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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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18
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Chen K, Huang HH, Aydin H, Tan YH, Lau WKO, Cheng CWS, Yuen JSP. Renal cell carcinoma in patients with end-stage renal disease is associated with more favourable histological features and prognosis. Scand J Urol 2015; 49:200-4. [PMID: 25783025 DOI: 10.3109/21681805.2015.1019561] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE End-stage renal disease (ESRD) patients with acquired cystic kidney disease are at higher risk of developing renal cell carcinoma (RCC) than the general population. The aim of this study was to investigate the clinical and histopathological differences between ESRD patients and the general population with RCC. MATERIALS AND METHODS Data were retrospectively collected from all nephrectomies performed for localized RCC from 2000 to 2010. Age at nephrectomy, gender, race, symptoms, baseline Eastern Cooperative Oncology Group (ECOG) performance status, Charlson Comorbidity Index score and histological data were extracted. Independent-samples t test and Mann-Whitney test were used for quantitative data, while chi-squared (two-sided) and Fisher's exact tests were used for qualitative data. RESULTS This study included 627 patients: 73 with and 554 without ESRD. The majority of patients were Chinese. The male to female ratio of 2:1 was identical in both groups. Baseline ECOG performance status and Charlson Comorbidity score were higher in the ESRD group. RCC in ESRD patients was more frequently asymptomatic (56.2% vs 44.9%, p = 0.071), diagnosed earlier (53.6 ± 11.8 years vs 57.9 ± 12.2 years, p = 0.004) and of lower stage (p < 0.001). The ESRD cohort had a higher proportion of the papillary histological subtype (21.9% vs 9.7%, p < 0.001). Importantly, there was a trend towards more favourable outcomes in ESRD patients in terms of cancer-specific (p = 0.203) and relapse-free survival (p = 0.096). CONCLUSION This study suggests that RCC in ESRD patients is associated with more favourable clinical and histological features and oncological outcome compared with that in patients with normal renal function.
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19
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Breda A, Lucarelli G, Luccarelli G, Rodriguez-Faba O, Guirado L, Facundo C, Bettocchi C, Gesualdo L, Castellano G, Grandaliano G, Battaglia M, Palou J, Ditonno P, Villavicencio H. Clinical and pathological outcomes of renal cell carcinoma (RCC) in native kidneys of patients with end-stage renal disease: a long-term comparative retrospective study with RCC diagnosed in the general population. World J Urol 2014; 33:1-7. [PMID: 24504760 DOI: 10.1007/s00345-014-1248-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/21/2014] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Patients with end-stage renal disease (ESRD) have an increased risk of developing renal cell carcinoma (RCC). This retrospective study compared clinical and pathological outcomes of RCC occurring in native kidneys of patients with ESRD (whether they underwent kidney transplantation or not) with those of renal tumors diagnosed in the general population. METHODS The study included a total of 533 patients with RCC. The ESRD cohort included 92 patients with RCC in native kidneys. Of these, 58 and 34 cases were identified before (pre-Tx group) and after kidney transplantation (post-Tx group), respectively. The control group was composed of 441 RCCs diagnosed in the general population. Variables were compared by chi-square and Student's t tests. Cancer-specific survival was assessed by Kaplan-Meier and Cox methods. RESULTS The ESRD groups had smaller (P = 0.001), lower-grade, and lower-stage tumors than the non-ESRD group (P = 0.001). The papillary RCC rate was higher in the ESRD groups (P = 0.01). Ten-year cancer-specific survivals were 94.5, 87.9, and 74.6 % in pre-Tx, post-Tx, and non-ESRD patients, respectively (P = 0.003). Mean follow-up was 90.2 months. At multivariate analysis, tumor size (HR = 1.10), pathological stage (HR = 1.46), presence of nodal (HR = 2.22) and visceral metastases (HR = 3.49), and Fuhrman grade (HR = 1.48) were independent adverse prognostic factors for cancer-specific survival. CONCLUSIONS Native kidney RCCs arising in ESRD patients are lower stage and lower grade as compared to RCCs diagnosed in the general population, and these tumors exhibit favorable clinical and outcome features.
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Affiliation(s)
- Alberto Breda
- Department of Urology, Fundació Puigvert, Universitat Autonòma de Barcelona, c/Cartagena 340-350, 08025, Barcelona, Spain,
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20
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Jung YT, Lee JJ, Lee SH, Lee AL, Huh KH, Kim MS, Kim SI, Kim YS, Joo DJ. Clinical Characteristics and Risk Factors for Renal Cell Carcinoma after Kidney Transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2013. [DOI: 10.4285/jkstn.2013.27.3.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Yun Tae Jung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Jun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Su Hyung Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - A-Lan Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Ha Huh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Myoung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Yu Seun Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Jin Joo
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
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21
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Sun IO, Ko YM, Kim EY, Park KS, Jung HS, Ko SH, Chung BH, Choi BS, Park CW, Kim YS, Yang CW. Clinical characteristics and outcomes in renal transplant recipients with renal cell carcinoma in the native kidney. Korean J Intern Med 2013; 28:347-51. [PMID: 23682229 PMCID: PMC3654133 DOI: 10.3904/kjim.2013.28.3.347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 05/09/2012] [Accepted: 06/11/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND/AIMS We investigated the incidence and clinical characteristics of renal cell carcinoma (RCC) in the native kidney of renal transplant recipients. METHODS Between 1991 and 2010, 1,425 patients underwent kidney transplantation at our institution. We retrospectively evaluated the clinical features and outcomes in renal transplant patients with RCC in the native kidney after renal transplantation. RESULTS The patients included three males and two females with a mean age of 63 years (range, 52 to 74). The incidence of RCC was 0.35%. The median interval between renal transplantation and RCC occurrence was 16.2 years (range, 9 to 20). All of our patients with RCC had developed renal cysts either before (n = 3) or after (n = 2) renal transplantation. The mean duration of dialysis was 12 months (range, 2 to 39). Of the five patients, four underwent dialysis treatment for less than 8 months. All the RCCs were low grade at the time of diagnosis. Four patients underwent radical nephrectomy, and one patient refused the operation. The four patients who underwent radical nephrectomy showed no evidence of local recurrence or distant metastasis during the median follow-up of 2.9 years. However, the patient who did not undergo surgery developed spinal metastasis from the RCC 6 years later. CONCLUSIONS This study suggests that the follow-up period is an important factor for the development of RCC in renal transplant recipients, and more vigorous screening with a longer follow-up period is required in renal transplant recipients.
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Affiliation(s)
- In O Sun
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yu Mi Ko
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Eun Young Kim
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyung Seon Park
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hong Soon Jung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sun Hye Ko
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Byung Ha Chung
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Bum Soon Choi
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Cheol Whee Park
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong Soo Kim
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chul Woo Yang
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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22
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Urologic De Novo Malignancies After Kidney Transplantation: A Single Center Experience. Transplant Proc 2012; 44:1293-7. [DOI: 10.1016/j.transproceed.2011.11.063] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 11/04/2011] [Indexed: 01/20/2023]
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23
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Lee HH, Choi KH, Yang SC, Han WK. Renal cell carcinoma in kidney transplant recipients and dialysis patients. Korean J Urol 2012; 53:229-33. [PMID: 22536464 PMCID: PMC3332132 DOI: 10.4111/kju.2012.53.4.229] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Accepted: 07/26/2011] [Indexed: 11/18/2022] Open
Abstract
PURPOSE In a group of surgery patients diagnosed with renal cell cancer, those who underwent dialysis were compared with those who received a kidney transplant. MATERIALS AND METHODS The 43 subjects included in this study were patients who had been undergoing dialysis because of end-stage renal disease or had undergone kidney transplantation. The patients were diagnosed with renal cell carcinoma (RCC) during follow-up and underwent radical nephrectomy from May 1996 to December 2010. Their medical records were retrospectively analyzed as part of the study. RESULTS In the transplantation group, the renal replacement therapy period averaged 54 months, and the period from transplantation to RCC averaged 119 months (range, 0 to 264 months). In the dialysis group, RCC was observed after an average of 124 months (range, 2 to 228 months) of dialysis, and nephrectomy was then conducted. Acquired cystic kidney disease (ACKD) was found more frequently in the dialysis group, and it had a statistically relevant effect on the occurrence of RCC by comparison with the transplantation group (p<0.01). CONCLUSIONS Although the incidence rate of ACKD was significantly higher in the dialysis group among patients undergoing surgery for RCC, cancer was found even without ACKD development in some transplant recipients. Considering that the transplant recipients also underwent dialysis, an informative prospective study will be necessary to determine whether other immunosuppressive agents besides ACKD may function as a cancer risk factor.
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Affiliation(s)
- Hyung Ho Lee
- Department of Urology, Urologic Science Institute, Yonsei University College of Medicine, Seoul, Korea
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24
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Inoue T, Matsuura K, Yoshimoto T, Nguyen LT, Tsukamoto Y, Nakada C, Hijiya N, Narimatsu T, Nomura T, Sato F, Nagashima Y, Kashima K, Hatakeyama S, Ohyama C, Numakura K, Habuchi T, Nakagawa M, Seto M, Mimata H, Moriyama M. Genomic profiling of renal cell carcinoma in patients with end-stage renal disease. Cancer Sci 2012; 103:569-76. [PMID: 22145865 DOI: 10.1111/j.1349-7006.2011.02176.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The purpose of the present study was to determine the genomic profile of renal cell carcinoma (RCC) in end-stage renal disease (ESRD) by analyzing genomic copy number aberrations. Seventy-nine tumor samples from 63 patients with RCC-ESRD were analyzed by array comparative genomic hybridization using the Agilent Whole Human Genome 4 × 44K Oligo Micro Array (Agilent Technologies Inc., Palo Alto, CA, USA). Unsupervised hierarchical clustering analysis revealed that the 63 cases could be divided into two groups, Clusters A and B. Cluster A was comprised mainly of clear cell RCC (CCRCC), whereas Cluster B was comprised mainly of papillary RCC (PRCC), acquired cystic disease (ACD)-associated RCC, and clear cell papillary RCC. Analysis of the averaged frequencies revealed that the genomic profiles of Clusters A and B resembled those of sporadic CCRCC and sporadic PRCC, respectively. Although it has been proposed on the basis of histopathology that ACD-associated RCC, clear cell papillary RCC and PRCC-ESRD are distinct subtypes, the present data reveal that the genomic profiles of these types, categorized as Cluster B, resemble one another. Furthermore, the genomic profiles of PRCC, ACD-associated RCC and clear cell papillary RCC admixed in one tissue tended to resemble one another. On the basis of genomic profiling of RCC-ESRD, we conclude that the molecular pathogenesis of CCRCC-ESRD resembles that of sporadic CCRCC. Although various histologic subtypes of non-clear cell RCC-ESRD have been proposed, their genomic profiles resemble those of sporadic PRCC, suggesting that the molecular pathogenesis of non-CCRCC-ESRD may be related to that of sporadic PRCC.
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Affiliation(s)
- Toru Inoue
- Department of Molecular Pathology, Faculty of Medicine, Oita University, Oita, Japan
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Impact of Accidental Discovery of Renal Cell Carcinoma at Time of Renal Transplantation on Patient or Graft Survival. Transplantation 2011; 92:1123-8. [DOI: 10.1097/tp.0b013e3182339cdd] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Ploussard G, Chambade D, Meria P, Gaudez F, Tariel E, Verine J, De Bazelaire C, Peraldi MN, Glotz D, Desgrandchamps F, Mongiat-Artus P. Biopsy-confirmed de novo renal cell carcinoma (RCC) in renal grafts: a single-centre management experience in a 2396 recipient cohort. BJU Int 2011; 109:195-9. [PMID: 21810160 DOI: 10.1111/j.1464-410x.2011.10315.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To study the natural history of renal cell carcinoma (RCC) development in renal grafts and their management. PATIENTS AND METHODS We report a single-centre series of de novo RCC in allografts from a cohort of 2396 consecutive renal transplant recipients. RESULTS In all, 17 RCCs were detected in 12 patients, representing 0.5% of kidney recipients. The mean patient age was 55 years and the time to RCC diagnosis since transplantation was 13 years. The mean diameter of the RCC was 23 mm. Biopsies were taken in all cases. Concordance between biopsy and surgical specimens was 100% for nuclear grade and pathological type. Four graft removals were performed and six patients underwent nephron-sparing surgery (NSS). Two cryoablations were performed. Overall, nine papillary RCC, five clear cell carcinomas, and one chromophobe cell carcinoma were removed surgically. The mean follow-up was 43 months. One local recurrence was reported in a patient treated by NSS. CONCLUSIONS Our findings support evidence that radiological screening of kidney recipients allows the detection of small tumours for which a conservative management by NSS or non-surgically destructive techniques can be proposed with mid-term oncological safety. Systematic tumour biopsy may help in the management and treatment decision. Several questions remain unanswered such as the importance of mammalian target of rapamycin inhibitors in the chemoprevention of the recurrence and the genetic cell origin of RCC in renal grafts.
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Affiliation(s)
- Guillaume Ploussard
- Service d'Urologie, Département DUNE, IUH Université Paris Denis Diderot Hôpital Saint-Louis, France
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Cornelis F, Buy X, André M, Oyen R, Bouffard-Vercelli J, Blandino A, Auriol J, Correas JM, Pluvinage A, Freeman S, Solomon SB, Grenier N. De novo renal tumors arising in kidney transplants: midterm outcome after percutaneous thermal ablation. Radiology 2011; 260:900-7. [PMID: 21771957 DOI: 10.1148/radiol.11110122] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To retrospectively evaluate the midterm outcome of patients treated for primary renal cell carcinomas arising in kidney transplants with minimally invasive techniques. MATERIALS AND METHODS The institutional review board of each participating institution approved this retrospective study and waived informed consent. This study was HIPAA compliant. A request for cases through the European Society of Urogenital Radiology network was made to institutions for patients who fit the requirements outlined by the authors, and a prospective follow-up of recipients was performed. Twenty-four tumors were identified that developed in the renal allograft of 20 patients from 11 institutions who were treated with radiofrequency ablation (n = 19) or cryoablation (n = 5) between 2003 and 2010. Maximal diameter of masses was 6-40 mm (median, 19.5 mm). Twenty masses were solid, and four were type 4 cystic masses. Preablation biopsy was performed for solid tumors only. All images and biologic and biopsy reports were retrospectively reviewed. Significant differences were determined by using a paired t test before and after ablation. RESULTS Mean follow-up was 27.9 months (range, 7-71 months). Histopathologic examination revealed papillary carcinoma in 17 patients and clear cell carcinoma in three. Tumors were successfully treated with ultrasonographic guidance in six patients, with computed tomographic guidance in 10 patients, and with both in four patients. One case of infection of the tumor site and one case of transitory genitofemoral nerve injury were the only reported complications. No significant change of renal function was noted. Subsequent imaging follow-up did not reveal any case of recurrence in the ablative site. CONCLUSION Percutaneous thermal ablation of renal tumors occurring in renal grafts is effective, with low morbidity. .
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Affiliation(s)
- François Cornelis
- Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076 Bordeaux, France.
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Joshi R, Mammen K, Pawar B. Successful renal transplantation after two separate urinary tract malignancies. Indian J Urol 2011; 24:256-7. [PMID: 19468407 PMCID: PMC2684257 DOI: 10.4103/0970-1591.40625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A patient who was treated for renal cell carcinoma and transitional cell carcinoma, later presented with end stage renal disease. He was managed with hemodialysis and later underwent successful renal transplantation. There was no evidence of tumor recurrence nearly nine years post-renal transplantation.
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Clear cell papillary renal cell carcinoma in the bilateral native kidneys after 2 years of renal transplantation: report of a case and review of the literature. Case Rep Transplant 2011. [PMID: 23198258 PMCID: PMC3504274 DOI: 10.1155/2011/387645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Renal transplantation increases the probability of malignant tumors by about 2–4-fold overall with a much higher rate for renal epithelial malignancy. Renal tumors in renal transplant recipients are commonly conventional clear cell or papillary renal cell carcinoma. Clear cell papillary renal cell carcinoma is a recently described unique renal epithelial neoplasm with scant eosinophilic or moderate amount of clear cytoplasm and pyknotic small nuclei oriented commonly toward the apical surfaces. No such tumor has been reported in renal transplant recipients. In this paper, we describe a clear cell papillary renal cell carcinoma involving bilateral native kidneys in a patient who had received a renal transplant 2 years earlier. Clear cell papillary renal cell carcinoma commonly presents with low pathologic stage and lower Fuhrman grade and is clinically indolent. Additional cases are needed to evaluate the clinical behavior of this type of tumor in renal transplant recipients.
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Leveridge M, Musquera M, Evans A, Cardella C, Pei Y, Jewett M, Robinette M, Finelli A. Renal cell carcinoma in the native and allograft kidneys of renal transplant recipients. J Urol 2011; 186:219-23. [PMID: 21575970 DOI: 10.1016/j.juro.2011.03.032] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Indexed: 12/29/2022]
Abstract
PURPOSE Renal cell carcinoma develops in renal transplant recipients 30 or more times more commonly than in the general population. We assessed the prevalence, histology and outcome of renal cell carcinoma in a large, single center recipient population. MATERIALS AND METHODS We examined outcomes in patients who underwent renal transplantation at our center to determine the prevalence, histology and outcome of those in whom renal cell carcinoma developed. RESULTS A total of 3,568 patients received a renal allograft at our institution between 1966 and 2009. A total of 45 renal cell carcinomas were diagnosed in the native kidney of 39 patients (1.1%) and in 8 (0.2%) renal cell carcinoma developed in the allograft kidney. Mean age at diagnosis was 51.6 and 48.2 years in patients with native kidney and allograft tumors, respectively. The mean interval between transplantation and the native or allograft renal cell carcinoma diagnosis was 10.6 and 12.1 years, respectively. Clear cell renal cell carcinoma was the most common tumor histology in native kidneys, diagnosed in 21 cases, while papillary renal cell carcinoma was diagnosed in 20. Five allograft tumors were papillary renal cell carcinoma and 3 were clear cell renal cell carcinoma. Native kidney tumors were managed by radical nephrectomy in 44 or by observation after biopsy. Allograft tumors were managed by transplant nephrectomy in 3 cases, radio frequency ablation in 3 and partial nephrectomy in 2. At a mean 6.6-year followup 32 patients with native kidney renal cell carcinoma were alive while 7 with allograft tumors were alive at a mean 3.6-year followup. CONCLUSIONS Renal cell carcinoma is more prevalent in patients with renal transplantation than the general population, although the subtype distribution differs. Excellent survival is seen at more than 6 years after treatment.
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Affiliation(s)
- Michael Leveridge
- Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Cheung CY, Lam MF, Lee KC, Chan GSW, Chan KW, Chau KF, Li CS, Chan TM, Lai KN. Renal cell carcinoma of native kidney in Chinese renal transplant recipients: a report of 12 cases and a review of the literature. Int Urol Nephrol 2011; 43:675-80. [PMID: 21547472 PMCID: PMC3160549 DOI: 10.1007/s11255-011-9912-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 02/05/2011] [Indexed: 11/29/2022]
Abstract
Objectives To present and discuss the epidemiological and clinical aspects, as well as therapeutic options and outcome of de novo renal cell carcinoma (RCC) of the native kidneys in a series of Chinese renal transplant recipients. Patients and Methods A retrospective, cohort study examining all renal transplant recipients with the diagnosis of RCC of native kidney followed up in two major regional hospitals in Hong Kong between January 2000 and December 2009. Clinical data included age, gender, cause of renal failure, symptoms at presentation, duration of transplantation, immunosuppressive therapy, and history of acquired cystic kidney disease (ACKD). Laboratory, radiographic, operative, and pathology reports were used to assess the tumor extent. Results Among the 1,003 renal transplant recipients recruited, 12 transplant recipients had a nephrectomy for a total of 13 RCC. The prevalence of de novo RCC was 1.3%. The mean age at diagnosis of RCC was 48.4 years, and the median time from transplantation to diagnosis was 6.1 years. ACKD was found in 6 (50%) of the patients. All patients except one were asymptomatic. pT1 disease was found in ten patients with a mean tumor size of 3.2 cm. All patients were treated successfully with radical nephrectomy. After a median follow-up of 38 months, two patients (16.7%) died. One died of sepsis, and the other died of metastatic carcinoma. Conclusions With increasing data showing a better prognosis if RCC is detected early by screening, it is time to consider screening all kidney transplant recipients for ACKD and RCC.
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Affiliation(s)
- Chi Yuen Cheung
- Renal Unit, Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong
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Neuzillet Y, Tillou X, Mathieu R, Long JA, Gigante M, Paparel P, Poissonnier L, Baumert H, Escudier B, Lang H, Rioux-Leclercq N, Bigot P, Bernhard JC, Albiges L, Bastien L, Petit J, Saint F, Bruyere F, Boutin JM, Brichart N, Karam G, Branchereau J, Ferriere JM, Wallerand H, Barbet S, Elkentaoui H, Hubert J, Feuillu B, Theveniaud PE, Villers A, Zini L, Descazeaux A, Roupret M, Barrou B, Fehri K, Lebret T, Tostain J, Terrier JE, Terrier N, Martin L, Dugardin F, Galliot I, Staerman F, Azemar MD, Irani J, Tisserand B, Timsit MO, Sallusto F, Rischmann P, Guy L, Valeri A, Deruelle C, Azzouzi AR, Chautard D, Mejean A, Salomon L, Rigaud J, Pfister C, Soulié M, Kleinclauss F, Badet L, Patard JJ. Renal cell carcinoma (RCC) in patients with end-stage renal disease exhibits many favourable clinical, pathologic, and outcome features compared with RCC in the general population. Eur Urol 2011; 60:366-73. [PMID: 21377780 DOI: 10.1016/j.eururo.2011.02.035] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Accepted: 02/20/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) are at risk of developing renal tumours. OBJECTIVE Compare clinical, pathologic, and outcome features of renal cell carcinomas (RCCs) in ESRD patients and in patients from the general population. DESIGN, SETTING, AND PARTICIPANTS Twenty-four French university departments of urology participated in this retrospective study. INTERVENTION All patients were treated according to current European Association of Urology guidelines. MEASUREMENTS Age, sex, symptoms, tumour staging and grading, histologic subtype, and outcome were recorded in a unique database. Categoric and continuous variables were compared by using chi-square and student statistical analyses. Cancer-specific survival (CSS) was assessed by Kaplan-Meier and Cox methods. RESULTS AND LIMITATIONS The study included 1250 RCC patients: 303 with ESRD and 947 from the general population. In the ESRD patients, age at diagnosis was younger (55 ± 12 yr vs 62 ± 12 yr); mean tumour size was smaller (3.7 ± 2.6 cm vs 7.3 ± 3.8 cm); asymptomatic (87% vs 44%), low-grade (68% vs 42%), and papillary tumours were more frequent (37% vs 7%); and poor performance status (PS; 24% vs 37%) and advanced T categories (≥ 3) were more rare (10% vs 42%). Consistently, nodal invasion (3% vs 12%) and distant metastases (2% vs 15%) occurred less frequently in ESRD patients. After a median follow-up of 33 mo (range: 1-299 mo), 13 ESRD patients (4.3%), and 261 general population patients (27.6%) had died from cancer. In univariate analysis, histologic subtype, symptoms at diagnosis, poor PS, advanced TNM stage, high Fuhrman grade, large tumour size, and non-ESRD diagnosis context were adverse predictors for survival. However, only PS, TNM stage, and Fuhrman grade remained independent CSS predictors in multivariate analysis. The limitation of this study is related to the retrospective design. CONCLUSIONS RCC arising in native kidneys of ESRD patients seems to exhibit many favourable clinical, pathologic, and outcome features compared with those diagnosed in patients from the general population.
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Tsaur I, Obermüller N, Jonas D, Blaheta R, Juengel E, Scheuermann EH, Kachel HG, Karalis A, Probst M. De novo renal cell carcinoma of native and graft kidneys in renal transplant recipients. BJU Int 2010; 108:229-34. [DOI: 10.1111/j.1464-410x.2010.09856.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Wong G, Howard K, Webster AC, Chapman JR, Craig JC. Screening for renal cancer in recipients of kidney transplants. Nephrol Dial Transplant 2010; 26:1729-39. [PMID: 20961889 DOI: 10.1093/ndt/gfq627] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Renal cancer is the most common solid organ cancer in the kidney transplant population with an excess risk ~ 5-fold greater than the general population. It is uncertain whether routine screening for renal cancer is cost-effective. The aim of our study is to estimate the costs and health benefits of ultrasonographic (US) screening for renal cancer in the kidney transplant population. METHODS A Markov model was developed to compare the costs and benefits in a cohort of kidney transplant recipients (n = 1000, aged 18-69 years), who underwent annual and biennial US screening for renal cancer, compared with a cohort that did not. RESULTS For recipients of kidney transplants aged 18-69 years, the incremental cost-effectiveness ratio (ICER) for routine US screening ranged from $252,100/LYS for biennial screening to $320,988/LYS for annual screening. A total of two and one cancer deaths were averted in the annually and biennially screened population, with a relative cancer-specific mortality reduction by 25% and 12.5%, respectively. Using a series of sensitivity analyses, the ICER was most sensitive to the costs and test specificity of ultrasonography, prevalence of disease, and the risk of graft failure in the screened population. CONCLUSIONS Routine screening for renal cancer may reduce the risk of cancer-related deaths in recipients of kidney transplants. Uncertainties, however, exist in the model's influential variables including the risk of graft failure among those who received contrast-enhanced diagnostic computer tomography. Given the available evidence, routine screening for renal cancers may not be cost-effective for recipients of kidney transplants.
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Affiliation(s)
- Germaine Wong
- Centre for Kidney Research, The Children’s Hospital at Westmead, NSW, Australia.
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Parsa V, Heilbrun L, Smith D, Sethi A, Vaishampayan U. Safety and efficacy of sorafenib therapy in patients with metastatic kidney cancer with impaired renal function. Clin Genitourin Cancer 2010; 7:E10-5. [PMID: 19692316 DOI: 10.3816/cgc.2009.n.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Sorafenib is an oral Raf kinase inhibitor, approved for the treatment of advanced renal cancer. Clinical investigation of the safety and feasibility of sorafenib therapy in patients with impaired renal function was performed in this study. MATERIALS AND METHODS The protocol was approved by the Human Investigation Committee of Wayne State University. Medical records of patients with metastatic renal cancer at Wayne State University started on sorafenib between November 2005 to January 2007 were reviewed. Patients with a calculated creatinine clearance (CrCl) of 60 mL/min or less (chronic kidney disease stage 3 or greater per Kidney Disease Outcomes Quality Initiative guidelines) were deemed to have renal insufficiency. RESULTS A total of 32 patients who met the selection criteria were analyzed. Fourteen of 32 (44%) patients had renal insufficiency (range, 32-60 mL/min). Median age was 71 years in patients with CrCl < or = 60 mL/min and 54 years in those with > 60 mL/min. Incidence of diarrhea (57% vs. 33%) and hand-foot syndrome (86% vs. 56%) were higher in the renal-dysfunction group. Dose interruptions and dose reductions were noted in 57% and 43% of patients with renal dysfunction versus 28% and 22% in those without. No significant differences were noted in response rate, progression-free survival or overall survival. CONCLUSION Renal insufficiency is frequently observed in patients with advanced renal cancer. Sorafenib therapy can be safely delivered in patients with mild and moderate renal dysfunction, and efficacy appears to be maintained.
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Affiliation(s)
- Venkata Parsa
- Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
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Spectrum of abdominal pathologies detected with CT in long term dialysis patients. Eur J Radiol 2009; 72:306-13. [DOI: 10.1016/j.ejrad.2008.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 07/04/2008] [Indexed: 11/22/2022]
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Multidisciplinary treatment including sorafenib stabilized the bone metastases of renal cell carcinoma in an immunosuppressed renal transplant recipient. Int J Clin Oncol 2009; 14:465-7. [DOI: 10.1007/s10147-008-0868-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 12/04/2008] [Indexed: 01/15/2023]
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Abstract
OBJECTIVE To outline the features and outcomes of renal cell carcinoma (RCC) in native kidneys of renal transplant recipients, who are at increased risk of developing this disease. PATIENTS AND METHODS We retrospectively studied the clinicopathological features and survival of 28 surgically treated RCCs, which developed in 24 renal transplant recipients. Features and outcomes were compared with 671 patients with RCC who had no renal transplant. RESULTS The median interval between renal transplantation and the occurrence of RCC was 5.6 years. Acquired cystic kidney disease was present in 83% of the transplanted patients. Compared with the patients with RCC and no renal transplant, RCCs of native kidneys in transplant recipients were more frequently incidental findings (92% vs 77%, P = 0.092), multifocal (39% vs 15%, P < 0.001), bilateral (17% vs 4%, P = 0.006), had lower T stages (P = 0.040), were smaller (P = 0.027), of lower grades (P = 0.010), were more frequently papillary (43% vs 19%, P = 0.019) and occurred at a significantly younger age (P = 0.022). After a median follow-up of 6.7 years, eight renal transplant recipients had died (33%), but only two deaths were due to RCC. Survival with metastatic RCC was only 4 months, if a full resection of all metastatic sites was not achieved. In multivariate analysis the presence of a renal transplant had no effect on survival. CONCLUSIONS Most RCCs in renal transplant recipients are incidental low-stage, low-grade tumours with a favourable prognosis. The outstanding pathological findings are bilateral occurrence, papillary subtype and multifocality. Prognosis of metastatic RCC is poor but might be favourable if all metastases are resected. Screening for early detection of asymptomatic RCC is advocated.
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Hard GC, Johnson KJ, Cohen SM. A comparison of rat chronic progressive nephropathy with human renal disease—implications for human risk assessment. Crit Rev Toxicol 2009; 39:332-46. [DOI: 10.1080/10408440802368642] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Radiofrequency thermal ablation of small tumors in transplanted kidneys: an evolving nephron-sparing option. J Vasc Interv Radiol 2009; 20:674-9. [PMID: 19299170 DOI: 10.1016/j.jvir.2009.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 01/04/2009] [Accepted: 01/06/2009] [Indexed: 12/18/2022] Open
Abstract
Small tumors in transplanted kidneys are rarely detected during follow-up. With surgical treatment, it is sometimes challenging to preserve the graft and its function. Image-guided ablation techniques have been recently reported as effective in treating these tumors. Herein three cases of radiofrequency (RF) thermal ablation in transplanted kidneys are reviewed and compared with cases in the literature. There were no major complications seen, the mean change in serum creatinine level was no greater than 0.1 mg/dL, and complete ablation was sustained on imaging studies at 3, 18, and 62 months follow-up. RF ablation can be considered a safe, function-preserving, and effective evolving therapeutic option for small tumors in transplanted kidneys.
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Hora M, Hes O, Reischig T, Ürge T, Klec̆ka J, Ferda J, Michal M, Eret V. Tumours in End-Stage Kidney. Transplant Proc 2008; 40:3354-8. [DOI: 10.1016/j.transproceed.2008.08.135] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 08/12/2008] [Indexed: 01/20/2023]
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Chambade D, Meria P, Tariel E, Vérine J, De Kerviler E, Peraldi M, Glotz D, Desgrandchamps F, Mongiat-Artus P. Nephron Sparing Surgery is a Feasible and Efficient Treatment of T1a Renal Cell Carcinoma in Kidney Transplant: A Prospective Series From a Single Center. J Urol 2008; 180:2106-9. [DOI: 10.1016/j.juro.2008.07.055] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Indexed: 12/27/2022]
Affiliation(s)
- D. Chambade
- Department of Urology, Paris 7 University Saint-Louis Hospital, Paris, France
| | - P. Meria
- Department of Urology, Paris 7 University Saint-Louis Hospital, Paris, France
| | - E. Tariel
- Department of Urology, Paris 7 University Saint-Louis Hospital, Paris, France
| | - J. Vérine
- Department of Pathology, Paris 7 University Saint-Louis Hospital, Paris, France
| | - E. De Kerviler
- Department of Radiology, Paris 7 University Saint-Louis Hospital, Paris, France
| | - M.N. Peraldi
- Department of Nephrology, Paris 7 University Saint-Louis Hospital, Paris, France
| | - D. Glotz
- Department of Nephrology, Paris 7 University Saint-Louis Hospital, Paris, France
| | - F. Desgrandchamps
- Department of Urology, Paris 7 University Saint-Louis Hospital, Paris, France
| | - P. Mongiat-Artus
- Department of Urology, Paris 7 University Saint-Louis Hospital, Paris, France
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