Treatment options for renal cell carcinoma in renal allografts: a case series from a single institution

Abstract

Renal cell carcinoma (RCC) is more common in renal transplant and dialysis patients than the general population. However, RCC in transplanted kidneys is rare, and treatment has previously consisted of nephrectomy with a return to dialysis. There has been recent interest in nephron-sparing procedures as a treatment option for RCC in allograft kidneys in an effort to retain allograft function. Four patients with RCC in allograft kidneys were treated with nephrectomy, partial nephrectomy, or radiofrequency ablation. All of the patients are without evidence of recurrence of RCC after treatment. We found nephron-sparing procedures to be reasonable initial options in managing incidental RCCs diagnosed in functioning allografts to maintain an improved quality of life and avoid immediate dialysis compared with radical nephrectomy of a functioning allograft. However, in non-functioning renal allografts, radical nephrectomy may allow for a higher chance of cure without the loss of transplant function. Consequently, radical nephrectomy should be utilized whenever the allograft is non-functioning and the patient's surgical risk is not prohibitive.

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 …”

Nephron-Saving Surgery for Abscess of Renal Allograft Using Radiofrequency Bipolar Sealer

“…5 To our knowledge, our patient is the first case depicting the use of RBS for partial nephrectomy for necrotic abscess of a renal allograft. 5 To our knowledge, our patient is the first case depicting the use of RBS for partial nephrectomy for necrotic abscess of a renal allograft.…”

De novo Renal Cell Carcinoma in a Kidney Allograft with Focus on Contrast-Enhanced Ultrasound

“…CT scan and arteriography, conventional ultrasonography, percutaneous targeted renal biopsy and magnetic resonance imaging (MRI) are the most commonly described diagnostic tools in the literature [5,11,12]. However, both CT and MRI contrast agents are contraindicated in patients with renal impairment.…”

“…CEUS is minimally invasive, easy to use, cheap, and allows for reproducible measurements without adverse effects [14]. Papillary RCC seems to be the most predominant histological subtype in acquired cystic kidney disease-associated RCC in native kidneys (up to 70% compared to 10-15% in sporadic RCC) [15] but occurs also in transplanted kidneys [5,8,11], with unique described features on contrast-enhanced imaging as following: papillary RCC has less intratumoral vascularity and enhances less than clear-cell RCC in all phases of contrast-enhanced imaging [16]. This finding is in line with the present case confirming the diagnosis by CEUS, where the papillary tumor was enhanced after a bolus injection of contrast agent, but remained hypoechoic compared the surrounding renal parenchyma.…”