Features and outcomes of renal cell carcinoma of native kidneys in renal transplant recipients

Abstract

Study Type – Therapy (case series) Level of Evidence 4 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.

Incidence of Primary and Second Cancers in Renal Transplant Recipients: A Multicenter Cohort Study

“…Our data confirm the severe prognosis of posttransplant lymphomas (27). The detection of an excess mortality due to carcinoma of the native kidney in our cohort is in contrast with the reports of a favourable prognosis of this cancer in transplanted patients, if compared to nontransplanted patients (28,29). The reduced number of patients in our cohort, and the different study design of the studies cited, may possibly explain these discrepancies, that need to be further investigated.…”

Complete response of sunitinib therapy for renal cell cancer recurrence in the native kidney after renal transplantation: a case report

“…TKIs such as sunitinib and sorafenib may represent treatment options because they are not contraindicated in patients with a transplant under immunosuppressive therapy [9]. Tumor reductions of approximately 40% and 20% have been achieved previously with sunitinib and sorafenib, respectively [10–12].…”

Native Nephrectomy for Renal Cell Carcinoma in Transplant Recipients

“…Most of the current literature suggests excellent cure rates for transplant patients with localized disease who undergo nephrectomy, with disease specific mortality of 0% to 10% (4 -7, 9, 17). However, several of these studies include patients who had their surgery less than 1 year before the study (5,6,9,17), thus it may be premature to assume them cured. Nonetheless, our results suggest acceptable success rates, with 12 of 13 patients free of disease at a mean metastasis-free survival of 58.4 months and a mean follow-up of 60.6 months.…”

“…The patient with metastatic disease, the only one with gross hematuria, presented with the highest T stage and thus with the most advanced disease. Klatte et al (9) performed multivariate analysis on their population, and transplantation had no impact on survival. Tollefson et al (19) recommend against reducing immunosuppression in patients with nonmetastatic disease.…”