De novo renal cell carcinoma of native and graft kidneys in renal transplant recipients

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Immmunosuppression is an etablished risk factor for development of different maligancies. Nevertheless, little is known about the behaviour of renal cell cancer of native and graft kidneys in renal transplanted patients. The study results show an increased incidence of renal cell carcinoma in renal transplant recipients with high prevalence of papillary subtype, significantly younger patient age at the immunosuppression onset, aggressive behaviour with an increased tendency to systemic advance despite a high rate of low‐stage and low‐grade carcinomas at diagnosis. Furthermore, graft tumours had a more favourable prognosis than those of native kidney.

OBJECTIVE

• ? To access the epidemiological, clinical and survival features of renal transplant patients with de novo renal cell carcinoma of native and graft kidneys.

PATIENTS AND METHODS

• ? We performed a retrospective examination of the data of 2001 consecutive renal transplant recipients at our centre between November 1979 and January 2010.

RESULTS

• ? In the patient cohort examined, 30 renal cell carcinomas were observed in 26 individuals (incidence 1.5%) with 25 tumours in the native and five in allograft kidneys. Mean tumour size in surgical specimens was 44 ± 36 mm. The rate of papillary cancer was 37.5%.
• ? After a mean follow‐up of 58.6 ± 62.3 months, 15.4% of the patients died from cancer and 57.7% were in complete remission.
• ? Overall and tumour‐specific survival rates at 1, 5 and 10 years were 86.1%, 75.1% and 43.8%, and 90.4%, 83.5% and 66.8%, respectively.

CONCLUSIONS

• ? Due to increasingly improved survival after renal transplantation, de novo malignancies might soon become the main cause of intermediate‐ or long‐term mortality.
• ? Current data support an increased risk of renal cell carcinoma in renal transplant recipients in a particularly aggressive way, but low tendency for metachronous contralateral evolution.
• ? With continuous radiological follow‐ups, acceptable oncological outcome can be achieved. Graft tumours may have a favourable prognosis.