Renal cell carcinoma of native kidneys in renal transplant patients

To outline recent findings on renal cell carcinoma (RCC) of native kidneys in renal transplant patients.

The incidence of RCC in native kidneys of renal transplant patients varies between 0.3 and 4.8%. The risk is increased in patients with acquired cystic kidney disease, in men, African-Americans, recipients aged at least 65 years, those with a longer pretransplant dialysis interval, a donor aged at least 50 years, and microscopic hematuria. On the basis of the risk factor profile, periodic ultrasound screening is recommended. Most RCCs in renal transplant patients are incidental low-stage, low-grade tumors with a good prognosis. The outstanding pathological findings are bilateral occurrence, papillary subtype and multifocality. Minimally invasive radical nephrectomy can be performed safely in these patients. Systemic treatment of metastatic RCC represents a challenge, with rapamycin analogues being an attractive option.

The risk for RCC in native kidneys after renal transplantation is substantial. Multiple risk factors have been identified, although the exact risk-factor dependent screening protocol has yet to be determined. Most RCCs in renal transplant patients are low-stage, low-grade tumors with a good prognosis.