Thermoablative Treatment of De Novo Tumor in Kidney Allograft

Abstract

Background. The overall cancer risk increases in transplant patients, including in kidney allografts. This study aimed to analyze the outcome of patients with kidney allograft malignant tumors who underwent percutaneous thermal ablation. Methods. We included 26 renal allograft tumors, including 7 clear-cell renal cell carcinoma (RCCs), 16 papillary RCCs, 1 clear-cell papillary RCC, and 2 tubulocystic RCCs, treated in 19 ablation sessions. Outcomes of thermal ablation therapy were assessed, including technical success, adverse events, local tumor progression, development of metastases, survival after thermal ablation, and changes in renal function. Results. Success rate was achieved in all ablation sessions (primary success rate: 96%; secondary success rate: 100%). No adverse events were observed in grades 3, 4, or 5. The median follow-up period was of 34 mo (15–69 mo). Two patients died during follow-up from a cause independent of renal cancer. The median decrease in estimated glomerular filtration rate 1 y after procedure was −4 (interquartile range, −7 to 0) mL/min/1.73 m2. One patient returned to dialysis within the year of the procedure. Conclusions. Percutaneous thermal ablation shows convincing results for treating malignant renal graft tumors and should be a useful treatment option. The shorter hospitalization time, the advantage of avoiding a potentially challenging dissection of the transplant, and the excellent preservation of allograft function appear encouraging to extend this indication.

Tracing the evolving dynamics and research hotspots in the kidney neoplasm and nephron sparing surgery field from the past to the new era

“…Regarding to the therapeutic effects, TA could provide more favorable perioperative outcomes and possible long‐term RF preservation compared with PN, 83,158 and previous research also revealed similar short‐ and medium‐term cancer‐specific results 159 . It should be noted that this seems true even for transplant patients carrying a tumor on their kidney graft despite the few studies available 160 . However, a contemporary meta‐analysis demonstrated that TA conferred lower local recurrence‐free survival with one treatment, while reaching therapeutic equivalences with PN only after multiple treatments 161,162 .…”

“… 159 It should be noted that this seems true even for transplant patients carrying a tumor on their kidney graft despite the few studies available. 160 However, a contemporary meta‐analysis demonstrated that TA conferred lower local recurrence‐free survival with one treatment, while reaching therapeutic equivalences with PN only after multiple treatments. 161 , 162 Moreover, the therapeutic effect for cT1a patients was compared between different TA methods (heat‐based TA and cryoablation).…”