Solid Renal Masses in Transplanted Allograft Kidneys: A Closer Look at the Epidemiology and Management

Abstract

The objective of this review is to explore the available literature on solid renal masses (SRMs) in transplant allograft kidneys to better understand the epidemiology and management of these tumors. A literature review using PubMed was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Fifty-six relevant studies were identified from 1988 to 2015. A total of 174 SRMs in 163 patients were identified, with a mean tumor size of 2.75 cm (range 0.5-9.0 cm). Tumor histology was available for 164 (94.3%) tumors: clear cell renal cell carcinoma (RCC; 45.7%), papillary RCC (42.1%), chromophobe RCC (3%), and others (9.1%). Tumors were managed by partial nephrectomy (67.5%), radical nephrectomy (19.4%), percutaneous radiofrequency ablation (10.4%), and percutaneous cryoablation (2.4%). Of the 131 patients (80.3%) who underwent nephron-sparing interventions, 10 (7.6%) returned to dialysis and eight (6.1%) developed tumor recurrence over a mean follow-up of 2.85 years. Of the 110 patients (67.5%) who underwent partial nephrectomy, 3.6% developed a local recurrence during a mean follow-up of 3.12 years. The current management of SRMs in allograft kidneys mirrors management in the nontransplant population, with notable findings including an increased rate of papillary RCC and similar recurrence rates after partial nephrectomy in the transplant population despite complex surgical anatomy.

Radiofrequency thermal ablation of renal graft neoplasms: Case series and literature review

“…Median follow‐up was 15 months (range 7‐19); CT‐examinations during follow‐up showed no signs of disease relapse, extra‐renal spread, or needle tract seeding, with progressive minimal shrinking of the necrotic post‐ablation area (Figure ). Our results are in keeping with the literature …”

Hard-to-place kidney offers: Donor- and system-level predictors of discard

“…Common questions regarding the maximum histologic alteration allowed in a donor biopsy, the maximum acceptable pump resistive index, or the maximum DCD time‐to‐death are difficult to answer precisely, especially since the majority of reports contain a paucity of samples with advanced findings and are thus underpowered to detect modest differences in outcomes. There is a wide variety of anatomic abnormalities that have the potential to impact graft outcomes and donor findings concerning for cancer transmission that in aggregate are significantly associated with discard yet are rarely the subject of scientific studies . More data for these unmeasured characteristics should be assessed for outcomes and potentially considered for incorporation into risk adjustment models and/or as incentives for using higher‐risk donors.…”

Successful partial nephrectomy of a T1b multilocular clear cell renal cell carcinoma arising in a renal graft

“…The incidence of renal cell carcinoma in allografts is approximately 0.2% in the transplanted kidney population. The increasing survival of these patients is believed to be a factor in the rising incidence rate of this disease, 1 as well as the immunosuppression therapy, 2 , 3 , 4 , 5 especially the cyclosporine treatment.…”

“…There are approximately 160 cases of renal cancers arising in transplanted allografts described in the literature. 2 The sole worldwide review available to date describes 174 graft masses. Clear-cell carcinoma comprises the majority of cases, followed closely by papillary renal cell carcinoma, with a prevalence of Fuhrman grade II.…”

“…The prevalence of primary renal cell carcinoma in transplanted patients is reportedly 4.6%, owing to post-transplantation long-term immunosuppression therapy. 2 Surgical treatment is difficult because of local fibrosis and adhesions to the adjacent tissues. The most prevalent surgical option is total nephrectomy of the graft.…”