A national study of kidney graft tumor treatments: Toward ablative therapy

High‐Intensity Focused Ultrasonography and Radiofrequency Ablation of Renal Cell Carcinoma Arisen in Transplanted Kidneys: Single‐Center Experience With Long‐Term Follow‐Up and Review of Literature

“…The main limitation of this technique is the short follow‐up with respect to nephron‐sparing surgery, although recent data support the safety and long‐term effectiveness . Along the same lines, Guleryuz et al, comparing 14 thermoablations (RF or cryoablation) of RCCs in kidney transplants with 48 PNs and 30 transplant nephrectomies, states that nephron‐sparing management of small de novo transplant RCCs is now the treatment of choice, with similar oncologic and functional outcomes between PN and percutaneous approaches. The HIFU approach permits an additional reduction in invasiveness, avoiding needle insertion into the transplanted kidney and consequently the risk of hemorrhage or tumor seeding.…”

Transplant Radical Nephrectomy and Transplant Radical Nephroureterectomy for Renal Cancer: Postoperative and Survival Outcomes

“…Despite the possible benefits expected from routine non-oncologic transplant nephrectomy, routine excision is not the standard, because it is a technically demanding procedure [ 13 , 14 ]. Even without the presence of malignancy, transplant radical nephrectomy of a failed allograft is associated with improvement in hematological, biochemical, and clinical parameters, such as erythropoietin (EPO) resistance index, serum levels of albumin, prealbumin, ferritin, fibrinogen, c-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) [ 15 , 16 ].…”

Treatment options for localised renal cell carcinoma of the transplanted kidney

“…There is no consensus among the transplant community on the optimal staging work up. Contrast-enhanced abdomen CT scan and MRI with or without contrast material are the preferred imaging techniques in most centres[ 7 , 14 , 18 , 34 ]. Albeit recommended by the American Urology Association (AUA) guidelines[ 32 ] and the European Association of Urology (EAU) guidelines[ 33 ], contrast-enhanced chest CT scan is seldom included in KTx RCC staging protocols.…”

“…The outcomes reported in renal allografts seem to contradict this opinion and suggest that tumour growth pattern may not be a relevant prognostic factor of primary treatment failure. According to the literature, the vast majority of localised allograft RCC successfully treated with NNS or AT is less than 4 cm in maximal diameter, Fuhrman grade 1-2, and staged T1aN0M0[ 14 , 18 , 34 ]. Conservative management of T1bN0M0 RCC remains anecdotal and seems to offer mixed outcomes[ 14 , 38 - 41 ].…”

“…Possible limitations, at least as shown in native kidneys, are higher risk of intra-operative bleeding[ 55 ], higher rate of primary treatment failure in case of neoplasms greater than 3 cm in maximal diameter[ 56 - 58 ], and higher recurrence rate for tumours with an endophytic growth pattern[ 59 ]. To date, only 10 cases of biopsy-proven T1aN0M0 and 1 case of biopsy-proven T1bN0M0 RCC of the transplanted kidney treated by cryoablation have been documented[ 34 , 60 - 63 ]. The procedures were mostly performed percutaneously under US- or CT-guidance with no persisting disease, no local relapse (post-ablation follow-up ranging from 1 to 59 mo), and excellent allograft function.…”