Acquired Renal Cystic Disease in Renal Transplant Recipients

Abstract

End-stage kidneys are known to undergo cystic transformation in patients treated with long-term hemodialysis. Little has been published, however, on the occurrence of acquired renal cystic disease (ACD) in renal transplant recipients. The available clinical and histopathological data were gathered on 22 renal transplant recipients who had undergone either necropsy or nephrectomy. None of our patients exhibited cystic changes in their donor kidneys. However, 11 patients (50%) had ACD of the native kidneys while the remaining patients lacked ACD. The duration of dialysis prior to transplantation was significantly longer and the life of the functional transplant kidney was significantly shorter in the ACD group as compared to the noncystic group. The combined duration of ESRD (dialysis + transplantation), however, was comparable in the two groups. It thus appears that the presence of a functioning renal allograft somehow retards the evolution of cystic changes in the diseased native kidneys. 1 of the patients in the ACD group exhibited superimposed multifocal clear cell carcinoma of the affected kidney, while none of the patients in the noncystic group exhibited renal neoplasm.

Cystic Transformation in Native Kidneys in Renal Allograft Recipients with Long-Standing Good Function

“…The overall incidence of cysts in these groups (36.1 and 42.6%) was compatible with previous reports Years after renal transplantation [3][4][5]12] which investigated more than 22 transplant recipients. This incidence (36-43%) or renal cysts in transplant recipients with good graft function is much higher than that (0-7%) for the general population in the same age groups of 20-40 years [13,14].…”

“…Vaziri et al [3] reported a 50% rate of acquired cysts in their 22 autopsy or nephrectomy cases. Bommer et al [15], Mickisch et al [16] and Krempien et al [17] also reported the high incidences (75-100%) of cysts in the native kidney after renal transplantation in studies of 2-9 patients.…”

Acquired Renal Cystic Disease and Adenocarcinoma following Renal Transplantation – A Current Urologic Perspective

“…ACKD may regress after successful renal transplantation, and early renal transplantation in ESRD patients may prevent or impede the development of ACKD [15,16]. However, ACKD occurs in native kidneys following successful renal transplantation as in case 2 [17,18].…”

Uremic Acquired Renal Cystic Disease

“…The prevalence of acquired cystic disease in hemodi alysis, CAPD and transplant patients is 35.2-79.3 [2,4,5,7,28], 29-54 [11,12] and 37-50% [17,34], respectively. These prevalence rates are derived from a number of studies with varying numbers of patients and durations of dialysis and recovery from transplantation; at first glance, there is apparently no significant difference among the three therapeutic modalities.…”

“…Such levels of interest are also demonstra ted by many clinicians and nephrologists because of the reported high incidence of complications -renal tumors and retroperitoneal bleeding -associated with acquired renal cysts [2][3][4][5][6][7][8][9]. Over the last 10 years, the natural history of acquired renal cystic disease has become clearer [10] and, more recently, its relationship to continuous ambu latory peritoneal dialysis [9,[11][12][13][14][15][16] or renal transplanta tion [17][18][19][20][21][22][23] has been investigated. However, there is some dispute concerning what method and frequency of screening should be used for the early detection of renal cell carcinoma in dialysis patients, since some authors [7,9,[24][25][26] remain skeptical of the high incidences of this cancer among such patients.…”