Renal Cell Carcinoma in Kidney Transplant Candidates

An increased incidence of renal cell carcinoma (RCC) has been observed in patients with end-stage renal disease. However, the incidence of this pathological condition has not been studied adequately in kidney transplant candidates. The aim of this study was to examine the incidence of RCC and the clinical, imaging, and pathological characteristics in this population.

At our institution, the majority of kidney transplant candidates undergo a non-contrast abdominal computerized tomography (CT) scan as a pre-transplant screening evaluation method. We retrospectively reviewed the medical data from 637 patients who were referred to our institution for kidney transplant evaluation during a period of 2 years. Of these, 174 were found ineligible and were excluded from the study; the final population consisted of 463 patients. Radical nephrectomy was proposed and performed in all the patients with findings highly suspicious of malignancy.

A total of 20 patients had findings suspicious for kidney malignancy on non-contrast CT scan and underwent a total nephrectomy before transplantation. At the pathological examination, 13 patients had malignant lesions and 4 patients had benign lesions. All patients with malignancy were male, and 9 of 13 patients with malignancy had papillary RCC.

This study confirms the increased incidence of RCC in kidney transplant candidates and underlines the utility of non-contrast CT scan without an intravenous contrast agent as a very useful screening tool in the pre-operative evaluation of kidney transplant candidates. Hence, we recommend the implementation of routine screening with non-contrast CT scan in all kidney transplant candidates who undergo hemodialysis.