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Kidney Week

Abstract: SA-PO049

Kidney Cancer After Renal Transplant: 14 Year Review

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Hu, Dennis, Eastern Virginia Medical School, Norfolk, Virginia, United States
  • Rijhwani, Suresh K., Nephrology Associates of Tidewater, Norfolk, Virginia, United States
  • Rust, Harlan C., Nephrology Associates of Tidewater, Norfolk, Virginia, United States
  • Hussein, Usama T., Nephrology Associates of Tidewater, Norfolk, Virginia, United States
  • Magoon, Sandeep, Nephrology Associates of Tidewater, Norfolk, Virginia, United States
  • McCune, Thomas R., Nephrology Associates of Tidewater, Norfolk, Virginia, United States
Background

Renal transplant patients are 7 times more likely than the general population to have renal cell carcinoma (RCC). Possible explanations include immunosuppression leading to increased oncogenic viral infections and acquired cystic kidney disease from hemodialysis. Due to the rapid growth and metastasis of RCC, renal ultrasounds (US) have been used as a screening tool; however, there is no uniform guideline on US frequency after renal transplantation.

Methods

Retrospective chart review of 962 renal transplant recipients at Sentara Norfolk General Hospital from 7/1/04-9/30/17 was performed. All patients received similar immunosuppression regimens and serial US by protocol at year 1,3,5,7,9,11 and 13 after transplant. Data involving gender, race, age at transplant, underlying cause of ESRD, and US results were collected. Tumor characteristics including timing of development, mass location, pathology, staging, and outcome were assessed.

Results

27 RCC cases were diagnosed in 19 patients. RCC incidence was 2.8%. Multifocal RCC was seen in 4 patients (3 at the same interval, 1 four years after previous nephrectomy) and all had bilateral nephrectomies. RCC was significantly higher in males than females (89% males, 11% females, p<0.05). Median time of RCC diagnosis was 3.55 years. Tumor staging was 78% T1aNxMx, 18% T1bNxMx, 4% T3aNxMx. All patients had nephrectomies.

Conclusion

Renal US at 2 year intervals after transplant captured all RCC cases. 5 patients were diagnosed in between the standard interval due to symptoms (e.g. hematuria). Men are at increased risk of RCC. Polycystic kidney disease is not associated with developing RCC. All RCC involved native kidneys and were cured with nephrectomy. Biannual US should be continued indefinitely after transplant and on any remaining kidneys after nephrectomy due to multi-centric occurrence.

US post-transplant (years)RCC cases/total RCC Age of transplant (years)RCC cases/total RCC Etiology of ESRDRCC cases/total RCC Tumor characteristicsRCC cases/total RCC
0-13.7% 30-4015% Hypertension44% Clear cell33%
1-322% 40-5022% Diabetes mellitus type 237% Papillary41%
3-548% 50-6030% Polycystic kidney disease4% Oncocytoma7%
5-719% 60-7033% Unspecified glomerulonephritis11% Chromophobe4%
7-90%    Calcineurin inhibitor nephrotoxicity of previous transplant4% Tubulocystic4%
9-113.7%       Unclassified11%
>113.7%