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Renal cell carcinoma in functional renal graft: Toward ablative treatments
Xavier Tillou1, Kerem Guleryuz2, Sylvie Collon3
1Urology and Transplantation Department, Caen University Hospital, Avenue Cote de Nacre, 14000 Caen, France; Medical University of Caen, Unicaen, Claude Bloch Street, 14000 Caen, France.
Abstract:
The occurrence of a kidney transplant tumor is a rare but serious issue with a double risk: the return to dialysis and the development of metastatic cancer. Publications on this topic are mainly case reports. The purpose of this review was to report an exhaustive literature review of functional graft renal cell carcinomas to highlight the impact of tumors on the renal graft outcomes. 201 de novo renal carcinomas in functional renal grafts from 69 publications were included. Incidence was estimated at 0.18%. Graft tumors were mostly asymptomatic (85.9%). Whatever the discovery circumstances of graft tumors, they were mostly documented by graft ultrasounds supplemented by CT-scanning or MR imaging. Nephron sparing surgery (95 patients) was the first treatment performed followed by radiofrequency ablation (38 patients) and cryotherapy (10 patients). The most common tumor graft histology was clear cell carcinoma (46.4%), followed by papillary carcinoma (43.7%). Specific mortality was 2.9% with 6 deaths. Renal graft cell carcinoma is a rare pathology with a low specific death. When possible, conservative treatment should be the first choice.
Insights
Kidney transplant tumors are rare but serious, risking dialysis return and cancer spread. Conservative treatments like nephron-sparing surgery are preferred for these renal cell carcinomas.
Area of Science:
- Nephrology
- Oncology
- Transplantation
Background:
- Renal cell carcinoma in kidney transplants is a rare complication.
- It poses risks of graft failure and metastatic cancer.
- Existing literature is primarily based on case reports.
Purpose of the Study:
- To conduct an exhaustive literature review of functional graft renal cell carcinomas.
- To highlight the impact of these tumors on renal graft outcomes.
- To analyze incidence, presentation, and treatment of de novo renal carcinomas in transplanted kidneys.
Main Methods:
- Systematic literature review of 69 publications.
- Inclusion of 201 de novo renal carcinomas in functional renal grafts.
- Data analysis of tumor histology, discovery methods, and treatment modalities.
Main Results:
- Estimated incidence of renal graft tumors at 0.18%.
- Most tumors were asymptomatic (85.9%) and detected via ultrasound, CT, or MRI.
- Clear cell carcinoma (46.4%) and papillary carcinoma (43.7%) were most common histologies.
- Nephron-sparing surgery was the primary treatment (95 patients).
- Specific mortality was low at 2.9%.
Conclusions:
- Renal graft cell carcinoma is a rare pathology with a low specific mortality rate.
- Conservative management, when feasible, should be the initial treatment of choice.
- Early detection and appropriate management are crucial for preserving graft function and patient survival.
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