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Orthotopic Rat Kidney Transplantation: A Novel and Simplified Surgical Approach
Published on: May 7, 2019
Conservative treatment of de novo renal carcinoma on kidney graft
I Cienfuegos-Belmonte1, E León-Dueñas1, M A Pérez-Valdivia1
1Unidad de Gestión Clínica de Urología-Nefrología, Hospital Universitario Virgen del Rocío, Sevilla, España.
Background:
De novo renal carcinoma in kidney transplants is an uncommon but not exceptional condition and is of significant importance due to the potential for recipient mortality and graft loss. The aim of our study was to determine the management and outcome of these tumors in our Kidney Transplantation Unit.
Material And Methods:
We analyzed cases of de novo kidney tumors among patients who underwent transplantation in the last 17 years in our Kidney Transplantation Unit. We detected 3 cases of clear cell carcinoma and 1 case of papillary carcinoma on the graft. We conducted follow-up on the tumor and renal function and analyzed patient responses to changes in immunosuppression.
Results:
Tumorectomy was performed in all cases, and subsequent transplantectomy was required for patients with papillary carcinoma. None of the patients had relevant surgical complications. We also changed the patients' regimen to a proliferation signal inhibitor or mTOR inhibitor and completely withdrew all anticalcineurin agents. With a mean follow-up of 43.5 months (15-61), the 3 patients with clear cell carcinoma survived with good graft function and with no evidence of tumor recurrence. The patient with papillary carcinoma underwent follow-up at another hospital center.
Conclusions:
Conservative surgery along with conversion to a proliferation signal inhibitor appears to be a safe option for treating primary tumors in kidney grafts and offers good oncological and renal function results in the short and medium term.
Insights
De novo kidney tumors in transplant recipients can be managed with conservative surgery and immunosuppression changes. This approach offers good oncological and graft function outcomes in the short to medium term.
Area of Science:
- Nephrology
- Oncology
- Transplantation Medicine
Background:
- De novo renal tumors in kidney transplant recipients are rare but serious complications.
- These tumors pose risks of mortality and graft loss.
- Effective management strategies are crucial for patient and graft survival.
Purpose of the Study:
- To evaluate the management and outcomes of de novo kidney tumors in transplant recipients.
- To assess the efficacy of surgical interventions and immunosuppression modifications.
Main Methods:
- Retrospective analysis of de novo kidney tumor cases over 17 years.
- Inclusion of 3 clear cell carcinoma and 1 papillary carcinoma cases.
- Monitoring of tumor status, renal function, and response to immunosuppression changes.
Main Results:
- Tumorectomy was performed in all cases; transplantectomy was needed for papillary carcinoma.
- No major surgical complications were reported.
- Patients switched to proliferation signal inhibitors or mTOR inhibitors, with calcineurin inhibitors withdrawn.
- Clear cell carcinoma patients showed survival with good graft function and no recurrence.
- Papillary carcinoma patient follow-up occurred at another center.
Conclusions:
- Conservative surgery combined with immunosuppression conversion to proliferation signal inhibitors is a safe treatment for primary kidney graft tumors.
- This strategy yields favorable short- and medium-term oncological and renal function results.
- Management of de novo tumors in kidney transplants requires tailored immunosuppression strategies.
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