Abstract: SA-PO520
Kidney Cancer after Renal Transplant: 9 Year Review
Session Information
- Immunosuppression, Disease Recurrence, and Malignancy
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Hu, Dennis, Eastern Virginia Medical School, Norfolk, Virginia, United States
- Rijhwani, Suresh K., Sentara Norfolk General Hospital, Norfolk, Virginia, United States
- Rust, Harlan C., Sentara Norfolk General Hospital, Norfolk, Virginia, United States
- Hussein, Usama T., Nephrology associates of tidewater, Virginia Beach, Virginia, United States
- Magoon, Sandeep, Nephrology Associates of Tidewater, Virginia Beach, Virginia, United States
- McCune, Thomas R., Sentara Norfolk General Hospital, Norfolk, Virginia, United States
Background
Renal transplant patients are at increased risk of renal cell carcinoma (RCC). The overall incidence of RCC following renal transplantation from 1987-2010 is 5.68 times higher than in the general population. Possible explanations include immunosuppression leading to DNA repair interference, decreased host immune surveillance with resulting unchecked tumor development, and increased oncogenic viral infections. Due to the rapid growth and metastasis of RCC, renal ultrasounds (US) have been used as a screening tool; however, there is no guideline on the frequency of US after renal transplantation.
Methods
Retrospective chart review of 543 renal transplant recipients (age 21-75 at transplant) at Sentara Norfolk General Hospital from 1/1/07-10/31/16 was performed. All patients received similar immunosuppression regimens and serial routine post transplant renal ultrasounds. Patient characteristics including gender, race, age at transplant, underlying cause of ESRD, and US at 1, 3, 5, 7, and 9 years post-transplant were collected. If renal malignancy was found, tumor characteristics including timing of development, mass location, pathology, staging, and outcome was assessed. RCC incidence was calculated based on timing of US post-transplant.
Results
RCC incidence was 2.2% and found in 92% males and 8% females. RCC was found in patients aged 30-40 (16%), 40-50 (25%), 50-60 (16%), and 60-70 (41%) years old at transplant. Incidence on 0-1, 1-3, 3-5, 5-7, and 7-9 year ultrasounds post-transplant were 0.18%, 0.73%, 1.29%, 0%, and 0%, respectively. Median time of RCC diagnosis was 3 years post-transplant. Tumor characteristics were clear cell (33%), papillary (33%), oncocytoma (13%), tubulocystic (6%), and unclassified (13%) . Staging was T1aNxMx (73%), T1bNxMx (20%), and T3aNxMx. (6.7%). 3 patients had different RCC in the same kidney. 1 patient had RCC 4.5 years after previous RCC. All patients had radical nephrectomies. Etiology of ESRD was HTN (33%), Diabetes (50%), and unspecified glomerulonephritis (16%).
Conclusion
US at 1,3,5 and 7 years post-transplant identified all RCCs and remained localized within the kidney.
Men are at increased risk of RCC.
PCKD is not associated with developing RCC.
Multicentric development of RCC suggests that follow-up of remaining kidney after nephrectomy is required.