Native nephrectomy for renal cell carcinoma in transplant recipients.

BACKGROUND: Dialysis patients and transplant recipients, especially those with acquired cystic kidney disease, are at increased risk for renal cell carcinoma (RCC). We report our experience in 15 posttransplant patients who underwent nephrectomy for renal masses.

METHODS: Institutional review board-exempt retrospective chart review was performed on 15 transplant recipients who subsequently underwent native nephrectomy for masses.

RESULTS: A total of 22 renal units were removed from 15 patients, with 18 kidneys removed laparoscopically and 4 via an open approach. Of those 22 kidneys, 17 units (77%) from 13 patients contained RCC. One kidney had two cancers, for a total of 18 cancers. The distribution of RCC is as follows: 11 papillary, 4 clear cell, and 3 chromophobe. Ten patients were stage T1N0M0, two patients were stage T2N0M0, and one was stage T3N0M0. No patients had immunosuppression withheld. The average length of stay for laparoscopic nephrectomy was 95 hr, with a median length of stay of 61 hr (range 33-360 hr). Surgical complications (7%) included a delayed extraction site hernia. There were no episodes of rejection, dialysis, or injury to the kidney. One patient developed pulmonary metastasis. Average follow-up and metastasis-free survival was 60.6 and 58.4 months, respectively.

CONCLUSIONS: Renal transplant recipients with suspicious masses or cancer or both can safely undergo native nephrectomy without jeopardizing their grafts by stopping immunosuppression. Immunosuppression does not seem to promote metastasis or recurrence, although longer follow-up is required. As in patients on hemodialysis, papillary RCC is more common than clear cell carcinoma.