Native Kidney Renal Cell Carcinoma in Renal Allograft Transplant Patients – Our Experience
Main Article Content
Keywords
immunosuppression, renal cell carcinoma, transplant
Abstract
The immunosuppression administered to renal transplant recipients to safeguard renal function elevates their susceptibility to renal cancer, which is estimated to be 15 times higher than in the general population. The current study aimed to analyze various aspects of native kidney renal cell carcinoma (RCC) in renal transplant recipients. This study involved a retrospective analysis of 11 patients who underwent nephrectomy for RCC in native kidneys among renal transplant recipients at our institution since 1992. Our institutional incidence was 0.4%. Median age at presentation was 57 (49–60) years. The ratio of male: female was 10:1. Most patients were asymptomatic at presentation and native kidney disease before transplantation was undetermined. In our study, the median time interval between diagnosis of RCC and transplant was 9.1 (8.4–11.2) years. All patients underwent native kidney nephrectomy. Clear cell type was more common than papillary type, 3.5 (2.5–4.2). Ten patients were diagnosed with stage I disease and one patient had stage IV disease. Fuhrman nuclear grading revealed low grades in nine patients and three patients had Grade 3. Immunosuppressive therapy modification was done in nine patients. Meticulous follow-up of renal transplant patients is essential for earlier diagnosis and appropriate treatment of native kidney RCC in transplant recipients. Authors recommend every year follow-up in transplant recipients with special emphasis on ultrasound of native kidney.
References
2. Penn I. Primary kidney tumors before and after renal transplantation. Transplantation. 1995;59:480. 10.1097/00007890-199502270-00006
3. Amin MB, Edge SB, Greene FL, Compton CC, Gershenwald JE, Brookland RK, et al., editors. AJCC cancer staging manual. 8th ed. Switzerland: Springer; 2017.
4. U.S. Renal Data System. USDRDS 2003 Annual Data Report: Atlas of End Stage Renal Disease in the United States. Bethesda, National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2003.
5. Filocamo MT, Zanazzi M, Marzi VL, Guidoni L, Villari D, Dattolo E, et al. Renal cell carcinoma of native kidney after renal transplantation: Clinical relevance of early detection. In Transplantation Proceedings, 2009 Dec 1 (Vol. 41, No. 10, pp. 4197–4201). Elsevier. 10.1016/j.transproceed.2009.08.082
6. Ianhez LE, Lucon M, Nahas WC, Sabbaga E, Saldanha LB, Lucon AM, et al. Renal cell carcinoma in renal transplant patients. Urology. 2007;69(3):462–4. 10.1016/j.urology.2006.11.007
7. Kanter J, Pallardó LM, Crespo JF, Gavela E, Beltrán S. Diagnóst ico de neoplasias en una consulta de t rasplante renal. Nefrologia 2009;29(4):311–17.
8. Kasiske BL, Vazquez MA, Harmon W, Brown RS, Danovitch GM. Recommendations for the outpatient surveillance of renal transplant recipients. American Society of Transplantation. J Am Soc Nephrol 2000;11(Suppl 15):S1–86. 10.1681/ASN.V11suppl_1s1
9. Fuhrman SA, Lasky LC, Limas C. Overview of the prognosis and treatment of renal cell carcinoma. Am J Surg Pathol. 1982;6(7):655–63. 10.1097/00000478-198210000-00007
10. Frank I, Blute ML, Leibovich BC, Cheville JC, Lohse CM. Independent validation of the 2002 American Joint Committee on cancer primary tumor classification for renal cell carcinoma using a large, single institution cohort. J Urol. 2005;173(6):1889–92. 10.1097/01.ju.0000158043.94525.d6
11. Fuhrman S, Lasky LC, Limas L. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol. 1982;6:655–63. 10.1097/00000478-198210000-00007
12. Dantal J, Hourmant M, Cantarovich D, Giral M, Blancho G, Dreno B, et al. Effect of long-term immunosuppression in kidney-graft recipients on cancer incidence: Randomised comparison of two cyclosporin regimens. Lancet. 1998;351:623–8. 10.1016/S0140-6736(97)08496-1
13. Gallagher MP, Kelly PJ, Jardine M, Perkovic V, Cass A, Craig JC, et al. Long-term cancer risk of immunosuppressive regimens after kidney transplantation. J Am Soc Nephrol. 2010;21:852–8. 10.1681/ASN.2009101043
14. Yang D, Thamcharoen N, Cardarelli F. Management of immunosuppression in kidney transplant recipients who develop malignancy. J Clin Med. 2019;8(12):2189. 10.3390/jcm8122189
15. Romagnoli J, Tagliaferri L, Acampora A, Bianchi V, D’Ambrosio V, D’Aviero A, et al. Management of the kidney transplant patient with cancer: Report from a Multidisciplinary Consensus Conference. Transplant Rev. 2021;35(3):100636. 10.1016/j.trre.2021.100636