De Novo Renal Cell Carcinoma of Native Kidneys in Renal Transplant Recipients: A Single-Center Experience

Abstract

Objectives: Our study aimed to determine the incidence of de novo renal cell carcinoma in the native kidneys of patients transplanted at our center and to identify possible risk factors. Materials and Methods: We performed a retrospective, single-center cohort study, which included patients transplanted at the District Hospital in Poznan, Poland, during 1994-2011, among whom 836 were selected. Sixty-three patients with confirmed de novo cancer were found. Of those, 11 had renal cell carcinoma in the native kidney (1.3%) and 2 in the transplanted kidney (0.2%). Results: Mean follow-up was 10 ± 3.2 years. Mean age at renal cell carcinoma diagnosis was 52 ± 9.4 years, and mean time from transplant was 3 ± 2.6 years. A statistical analysis showed no significant differences in demographic or clinical characteristics between renal cell carcinoma and noncancer group, except for the prevalence of male sex and smoking in the cancer group (P < .05). Conclusions: Renal cell carcinoma development in the native kidney seems to be an early event, frequently observed within 4 to 5 years after transplant. We believe that kidneys in renal transplant recipients should be routinely screened by ultrasound for early diagnosis.

De Novo Renal Cell Carcinoma of Native Kidneys in Renal Transplant Recipients: A Single-center Experience

“…It is well-established that the estimated rate of RCC development in native kidney is 10-to 100-times the incidence in the general, immunocompetent population (0.04%) (25,26), while RCC occurrence in the graft has been reported to be less frequent, accounting for approximately 10% of cases (5,27). Our series demonstrates one of the lowest incidences of RCC in native kidneys (0.5%) (11)(12)(13)(14)(15)(16)(28)(29)(30)(31)(32)(33)(34). Moreover, our results confirm those of a recent study and current literature findings, where the vast majority of renal malignancies were detected in the native kidneys of the recipients (85%) (33).…”

“…Native kidney and renal allograft are affected by both benign (9), and malignant or metastatic tumors more frequently than previously thought. The risk of renal cell carcinoma (RCC) development in renal transplant recipients is 15-100 times higher than in the general population (10)(11)(12) and the rate among all malignancies is less than 5% (11,(13)(14)(15)(16). The majority of RCCs found in transplant recipients develop in the recipient's native kidneys, with only 9% of tumors developing in the allograft itself.…”

Metastatic renal cell carcinoma: update on epidemiology, genetics, and therapeutic modalities

“… 8 , 9 In kidney transplant recipients, the risks of developing RCC from native kidneys are ten- to 100-fold greater compared with end-stage kidney disease patients on dialysis. 10 , 11 Apart from the traditional risk factors associated with RCC identified in the general population, there is a strong association between increasing dialysis duration pretransplant and development of RCC in kidney-transplant recipients. 8 , 12 The median time to diagnosis of RCC in the transplant recipients and general population is comparable, at 132 months (range 1–244 months), but RCCs in kidney-transplant recipients generally have a more favorable prognosis (except for stage IV RCC) compared with similar cancers in the general population.…”

“… 20 In contrast to the general population, papillary cell RCC is the predominant cancer type in kidney-transplant recipients (15% versus [vs] 44%) and is more likely to be bilateral and multifocal at initial presentation. 10 Chromophobe RCCs are relatively uncommon, and account for up to 5% of RCC in the general population. This tumor type rarely metastasizes and has the best prognosis, with 5-year survival approaching 90%, compared to 10% survival for patients with metastatic clear-cell or papillary RCC.…”

“…In kidney-transplant recipients, symptomatic disease and tumor size of >40 mm were associated with poorer survival following CN. 10 …”