Routine ultrasonography surveillance of native kidneys for renal cell carcinoma in kidney transplant candidates

Abstract

Renal cell carcinoma (RCC) has a high incidence in the kidney transplant population and annual surveillance detects these tumors early in their natural history. Minimal guidelines exist regarding RCC surveillance in ESRD patients awaiting transplant. A retrospective review of our kidney transplant database examined the outcomes of annual ultrasonographic surveillance during initial kidney transplant evaluation and upon annual reassessment. Of 2642 patients listed for transplant, 145 patients were found to have masses during initial kidney transplant evaluation or annual imaging consistent with new complex cystic disease or RCC. A total of 71 patients had RCC identified, with 52 found on initial kidney transplant evaluation and 19 identified on annual surveillance. Male gender and African-American race were independently associated with RCC (P<.05). RCC was detected a median of 2.0 years after listing (two annual ultrasonography studies). Patients with complex cysts were more likely to undergo transplantation (48.7%) compared to patients with RCC (21.1%; P<.001). There was no significant difference in survival between RCC patients and those found to have complex cystic disease, suggesting incidental RCC can be diagnosed early in the natural history and at a curable stage through implementation of a biennial surveillance program.

De Novo Renal Cell Carcinoma of Native Kidneys in Renal Transplant Recipients: A Single-center Experience

“…It is well-established that the estimated rate of RCC development in native kidney is 10-to 100-times the incidence in the general, immunocompetent population (0.04%) (25,26), while RCC occurrence in the graft has been reported to be less frequent, accounting for approximately 10% of cases (5,27). Our series demonstrates one of the lowest incidences of RCC in native kidneys (0.5%) (11)(12)(13)(14)(15)(16)(28)(29)(30)(31)(32)(33)(34). Moreover, our results confirm those of a recent study and current literature findings, where the vast majority of renal malignancies were detected in the native kidneys of the recipients (85%) (33).…”

“…Cigarette smoking, hypertension, obesity and family history are also well-established risk factors for RCC. Male gender and African American race were also independently associated with RCC (31).…”

Increased risk for renal cell carcinoma in end stage renal disease – a population-based case-control study

“…Despite having less advanced tumors at diagnosis, we showed that the OS in ESRD-RCC patients is significantly lower compared with RCC-only patients. In previous studies, ESRD-RCC patients showed a more favorable cancer-specific survival, compared with RCC patients only [8][9][10][11]28]. From a patient perspective, cancer specific survival only is less relevant for the ESRD-RCC patients since it does not capture the decreased survival due to ESRD.…”

Use of the contrast agent in the ultrasound diagnosis of kidney tumors

“…УЗИ чаще всего применяется первым в диагностическом алгоритме постановки диагноза [29,30]. Если раньше перед специалистами УЗИ ставились минимальные задачи выявления опухоли, то сегодня с усовершенствованием ультразвуковой техники появились возможности уточняющей диагностики.…”