Renal Cancer in Recipients of Kidney Transplant

Abstract

The aim of our study is to determine characteristics and outcomes of kidney cancer in renal transplant recipients. MEDLINE® database was searched in June 2015 to identify cases of kidney cancer in renal transplant recipients. We include also a new case. Descriptive statistics were used for analysis. Forty-eight (48) recipients reported in 25 papers met the eligibility criteria. The median age was 47 years (range 9-66); 27% were females. Chronic glomerulonephritis, cystic kidney disease and hypertension were common indications for renal transplant. Among donors 24% were females and the median age was 52.5 years (17-73); 62% of kidney cancers were donor-derived. The median interval between transplant and cancer diagnosis was shorter for cancer of recipient versus donor origin (150 vs. 210 days). Clear cell carcinoma was diagnosed in 17%. 25% had metastasis at diagnosis. Kidney explantation or excision was done in 90% and 84% of cases with and without metastasis respectively. The median survival was 72 months. Actuarial 1-year and 5-year survival rates were 73.4% and 55.1% respectively. Among the recipients from 7 donors who subsequently developed malignancy, 57% were dead within a year. Kidney transplant recipients have a small risk of kidney cancer, which affects younger patients and occurs within a year of transplant, likely due to immunosuppression. Whether the use of older donors may increase the likelihood needs further investigation. The presence of metastasis, explantation or excision of affected kidney and development of cancer in donors predict outcomes. The results may guide patient education and informed decision-making.

Incidence and Mortality of Renal Cell Carcinoma after Kidney Transplantation: A Meta-Analysis

“…Studies have shown that causes of ESRD before KTx may also affect the incidence of post-KTx RCC [14,32,35]. While KTx recipients with ESRD due to glomerulonephritis, hypertensive nephrosclerosis, and vascular diseases have been shown to have a higher incidence of post-KTx RCC, recipients with ESRD due to diabetic nephropathy carry a lower risk of post-KTx RCC [14,32,35,68]. KTx recipients are usually under intensified medical surveillance and the higher incidence of RCC among KTx recipients compared to general populations and ESRD patients might be due to detection bias.…”

Spontaneous regression of a metastatic carcinoma transmitted by a kidney graft

“…According to some researchers, if spontaneous regression is not observed, the residual neoplasm should be treated with radiation therapy, chemotherapy, or immunotherapy using agents such as INF-α or IL-2. After complete tumor regression, the repeated kidney transplantation should be delayed over the following tumor-free period for at least one year [11][12][13].…”

“…However, treatment of a patient with the disseminated tumor process implies that the graft removal is required, and after cessation of the immunosuppressive therapy, additional treatment is necessary such as radiotherapy, chemotherapy, or immunotherapy with alpha-interferon (INF-α) or interleukin-2 (IL-2) [9][10][11][12][13]. The attempts to use immune checkpoint inhibitors (ICI) in these patients have been also reported, though, despite the clinical effectiveness of this approach, the feasibility of ICI therapy seems doubtful due to a high rate of graft rejection [14].…”

Simultaneous living donor orthotopic renal transplantation and bilateral nephrectomy for recurrent renal cell carcinoma and renal failure: case report and review of literature

“…The transmission of malignancy from a donor’s organ to a recipient is rare, well known but frequently unavoidable complication of a renal transplantation. 14 The incidence or renal cell carcinoma (RCC) in renal transplant patients without nephrectomy ranges from 0.3% to 4.8%. Therefore, in patients with RCC, radical nephrectomy combined with renal transplantation represents an optimal treatment option in order to remove the risk of RCC infiltration into the transplanted kidney.…”