Elsevier

Transplantation Proceedings

Volume 40, Issue 10, December 2008, Pages 3354-3358
Transplantation Proceedings

Renal transplantation
Candidate
Tumours in End-Stage Kidney

https://doi.org/10.1016/j.transproceed.2008.08.135Get rights and content

Abstract

Objective

Patients with end-stage kidney disease (ESKD) show a greater risk for renal cell carcinoma (RCC), which tends to be multifocal and bilateral. The malignant potential is unclear. The question is whether to remove both kidneys in patients with a tumor on one side only diagnosed by computed tomography (CT).

Materials and Methods

Kidney tumors were found in 14 patients with ESKD from January 2002 to December 2006. One was unfit for surgery. Thirteen patients underwent nephrectomy and 6 a bilateral procedure of whom only 2 had bilateral tumors on CT, 3 multiple tumors on the contralateral side, and 1 uncontrollable hypertension with tumors as an incidental finding. Tumors were found in all 19 specimens.

Results

In 13 kidneys (68.4%), the tumors were multiple; in 6 (31.6%), solitary. The types of tumor were: 13 (68.4%) papillary RCCs (PRCC), 9 (47.4%) clear RCCs (CRCC), a combination of PRCC and CRCC in 4 (21.0%), and myxoid liposarcoma (with solitary PRCC contralaterally). The mean follow-up was short (19 ± 15 months; maximum, 54 months). Only 1 patient died due to a tumor at 16 months after operation.

Conclusions

There is a high risk for bilateral involvement. Patients who undergo unilateral nephrectomy must be regularly followed and contralateral nephrectomy carefully considered, mainly in transplanted patients on immunosuppression. Further studies are needed to give a definitive answer about the indications for surgery and the indications for contralateral nephrectomy as well. To date, prophylactic contralateral nephrectomy should not be a therapeutic standard.

Section snippets

Materials and Methods

At our institution, kidney tumors were found in 14 patients with ESKD from January 2002 to December 2006 (Table 1). Before 2002, we were not aware of these cases. We must mention that patients with ESKD are not regularly scheduled for follow-up graphic examinations of kidneys at our institution. The first cases in 2002 were a stimulus for a more active search for these tumours in ESKD. Incidental findings were obtained in 13 cases; in 1 case there were symptoms due to a rupture of a papillary

Results

The male-to-female ratio was 13:1. The mean age was 53.7 ± 10.5 years (range, 40.8–77.9 years). The mean time on dialysis (including potential transplantation) to the diagnosis of tumor was 78 ± 54 months (range, 0–154 months). Kidney tumors were found on CT in 13 patients, including 3 bilateral. In 1 patient who underwent bilateral nephrectomy for uncontrollable hypertension, multiple small tumors were found only in a histological specimen. Thirteen patients underwent nephrectomy, which was

Discussion

Denton et al4 pointed out the frequency of renal tumors in ESKD. At their institution, the majority of patients undergo an ipsilateral native nephrectomy at the time of transplantation. In a group of 260 kidney specimens were found: 33% acquired renal cystic disease (ARCD), 14% renal adenoma, 4.2% RCC, and 0.6% oncocytoma. The majority of RCC (91%) had underlying ARCD and 73% had coexisting papillary adenomas.4

Another question is, how frequent is multifocality and bilaterality of tumors in

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    This work was supported by Czech government research project MSM 0021620819.

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