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[Results of nephrectomy for native kidney tumors in renal transplanted patients]
X Tillou1, L Viart, M Demailly
1Service d'urologie et transplantation rénale, CHU Sud, avenue Laennec, 80000 Amiens, France. xavtillou@hotmail.com
Objective:
Evaluate epidemiology, diagnosis and outcome of de novo renal cell carcinoma in renal transplanted patients.
Patients And Method:
From June 1989 to December 2007, 824 renal transplantations were carried out and followed in annual consultation by an urologist with abdominal echography or tomodensitometry. The suspect renal lesions were treated by a widened nephrectomy. Incidence, diagnosis, treatment, histological type, and outcome of all patients were analysed.
Results:
Thirty-three patients had nephrectomy for suspect renal lesions. Twenty-two de novo tumours of native kidneys among 21 patients were diagnosed (15 renal clear cell carcinoma and seven papillary tumours) with mean time after transplantation of 25,6 months (2.3-105.5). All tumours were classified pT1aN0M0. Only one patient died at 8 months of metastatic dissemination of a papillary tumour classified initially pT1aN0M0. All the other patients are alive with mean follow-up of 34.8 months (2.8-113.9). Specific survival to 5 years was 93.3%.
Conclusion:
The increase risk of tumour at the renal transplanted patient led to propose in the event of suspect lesions of the native kidneys, a widened nephrectomy. In our series, 65% of the operated patients carried a cancer. The good forecast of these localized tumours justifies a regular radiological monitoring and an aggressive therapeutic attitude despite of absence of tumours in 35% of the transplanted patients.
Insights
Renal transplant recipients have an increased risk of de novo kidney cancer. Early detection and aggressive treatment, including widened nephrectomy for suspicious lesions, lead to a favorable prognosis with high survival rates.
Area of Science:
- Nephrology
- Oncology
- Transplantation
Context:
- Renal transplantation is associated with an increased risk of de novo malignancies.
- Monitoring for de novo tumors in native kidneys is crucial for renal transplant recipients.
Purpose:
- To evaluate the epidemiology, diagnosis, and outcomes of de novo renal cell carcinoma in renal transplant patients.
- To assess the efficacy of widened nephrectomy in managing suspicious renal lesions in this population.
Summary:
- A retrospective analysis of 824 renal transplantations identified 21 patients with de novo kidney tumors (22 lesions) in native kidneys.
- The majority of tumors were renal clear cell carcinoma or papillary tumors, all initially staged as pT1aN0M0.
- One patient died from metastatic disease, while the overall 5-year specific survival rate was 93.3%.
Impact:
- Aggressive management, including widened nephrectomy for suspicious native kidney lesions, is recommended.
- Regular radiological monitoring is essential for early detection of de novo tumors in renal transplant recipients.
- Despite a 35% rate of non-cancerous findings, the favorable prognosis of localized tumors supports this approach.
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