Outcomes of Patients With Localized Renal Cell Carcinoma on Immunosuppression Following Solid Organ Transplantation

To compare outcomes of patients with localized renal cell carcinoma (RCC) receiving immunosuppressive therapy due to prior organ transplant to a matched cohort of nontransplant patients.

Patients were identified from a solid organ transplant database with tissue diagnosis of nonmetastatic RCC after transplantation between 2000-2020. Transplant patients were matched to nontransplant patients with nonmetastatic RCC based on treatment type, age, tumor size, and grade if available. Clinical variables and survival outcomes were compared.

Among 81 transplant patients with nonmetastatic RCC (surgery 65%, ablation 23%, surveillance 11%), survival outcomes were comparable to matched nontransplant cohorts. In the surgical cohort, metastasis-free survival and overall survival did not differ between transplant and nontransplant patients, and multivariable analysis confirmed transplant status was not associated with increased risk of metastasis (HR 0.94, P = .9) or mortality (HR 1.58, P = .2). In the ablation cohort, transplant patients had better local recurrence-free survival (log-rank P = .01) compared to nontransplant patients. No difference was identified in metastasis-free or overall survival with regards to transplant status (HR 4.75, P = .2; HR 0.98, P = .9). Among patients managed with active surveillance, long-term follow-up demonstrated no differences in probability of treatment, metastatic progression, or survival, and transplantation was not associated with increased risk of death from any cause (HR 0.52, P = .5).

Across all management strategies, no difference was identified in outcomes for patients with nonmetastatic RCC after solid organ transplantation compared to nontransplant patients, despite chronic immunosuppression. Further studies should evaluate the role of active surveillance in this population.