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Nephron sparing surgery for De Novo kidney graft tumor: results from a multicenter national study
X Tillou1, K Guleryuz, A Doerfler
1Department of Urology, CHU de Caen, France.
Abstract:
Nephron sparing surgery (NSS) results in the transplanted population remain unknown because they are only presented in small series or case reports. Our objective was to study renal sparing surgery for kidney graft renal cell carcinomas (RCC) in a multicenter cohort. Data were collected from 32 French transplantation centers. Cases of renal graft de novo tumors treated as RCC since the beginning of their transplantation activity were included. Seventy-nine allograft kidney de novo tumors were diagnosed. Forty-three patients (54.4%) underwent renal sparing surgery. Mean age of grafted kidneys at the time of diagnosis was 47.5 years old (26.1-72.6). The mean time between transplantation and tumor diagnosis was 142.6 months (12.2-300). Fifteen tumors were clear cell carcinomas (34.9%), and 25 (58.1%) were papillary carcinomas. Respectively, 10 (24.4%), 24 (58.3%) and 8 (19.5%) tumors were Fuhrman grade 1, 2 and 3. Nine patients had postoperative complications (20.9%) including four requiring surgery (Clavien IIIb). At the last follow-up, 41 patients had a functional kidney graft, without dialysis and no long-term complications. NSS is safe and appropriate for all small tumors of transplanted kidneys with good long-term functional and oncological outcomes, which prevent patients from returning to dialysis.
Insights
Nephron sparing surgery (NSS) is safe for kidney transplant recipients with de novo tumors. This approach offers good oncological and functional outcomes, preventing the need for dialysis.
Area of Science:
- Nephrology
- Oncology
- Transplantation
Background:
- Nephron sparing surgery (NSS) outcomes in transplanted populations are not well-established.
- Existing data often comes from small case series or reports.
Purpose of the Study:
- To evaluate the safety and efficacy of renal sparing surgery for de novo kidney graft renal cell carcinomas (RCC).
- To assess long-term functional and oncological outcomes in a multicenter cohort.
Main Methods:
- Retrospective multicenter cohort study.
- Inclusion of de novo renal graft tumors treated as RCC across 32 French transplantation centers.
- Analysis of surgical interventions, tumor characteristics, postoperative complications, and long-term graft function.
Main Results:
- 79 de novo tumors were diagnosed in kidney allografts; 43 patients (54.4%) underwent NSS.
- Common tumor types included papillary (58.1%) and clear cell (34.9%) carcinomas.
- Postoperative complications occurred in 20.9% of patients, with 4 requiring further surgery.
- At last follow-up, 41 patients maintained a functional graft without dialysis or long-term complications.
Conclusions:
- Nephron sparing surgery is a safe and effective option for small tumors in transplanted kidneys.
- NSS provides favorable long-term functional and oncological results, preserving graft function and avoiding dialysis.
- This approach is recommended for managing de novo RCC in kidney transplant recipients.
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