Abstract: SA-PO049
Kidney Cancer After Renal Transplant: 14 Year Review
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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 ESRD | RCC cases/total RCC | Tumor characteristics | RCC cases/total RCC | |||
| 0-1 | 3.7% | 30-40 | 15% | Hypertension | 44% | Clear cell | 33% | |||
| 1-3 | 22% | 40-50 | 22% | Diabetes mellitus type 2 | 37% | Papillary | 41% | |||
| 3-5 | 48% | 50-60 | 30% | Polycystic kidney disease | 4% | Oncocytoma | 7% | |||
| 5-7 | 19% | 60-70 | 33% | Unspecified glomerulonephritis | 11% | Chromophobe | 4% | |||
| 7-9 | 0% | Calcineurin inhibitor nephrotoxicity of previous transplant | 4% | Tubulocystic | 4% | |||||
| 9-11 | 3.7% | Unclassified | 11% | |||||||
| >11 | 3.7% |