Noelle Cognard1, Dany Anglicheau2, Philippe Gatault3, Sophie Girerd4, Marie Essig5, Bruno Hurault de Ligny6, Yann Le Meur7, Franck Le Roy8, Cyril Garrouste9, Antoine Thierry10, Charlotte Colosio11, Joseph Rivalan12, Johnny Sayegh13, Gabriel Choukroun14, Bruno Moulin1, Sophie Caillard1. 1. Nephrology-Transplantation Department, University Hospital, Strasbourg, France. 2. Department of Nephrology and Kidney Transplantation, Necker Hospital, Paris, France. 3. Department of Nephrology and Clinical Immunology, CHRU and FHU Transplantation, Tours, France. 4. Department of Nephrology, University Hospital, Nancy, France. 5. Department of Nephrology, University Hospital, Limoges, France. 6. Department of Nephrology, University Hospital, Caen, France. 7. Department of Nephrology, University Hospital, Brest, France. 8. Department of Nephrology, University Hospital, Rouen, France. 9. Department of Nephrology, University Hospital, Clermont-Ferrand, France. 10. Department of Nephrology, University Hospital, Poitiers, France. 11. Department of Nephrology, University Hospital, Reims, France. 12. Department of Nephrology, University Hospital, Rennes, France. 13. Department of Nephrology, University Hospital, Angers, France. 14. Department of Nephrology, University Hospital, Amiens, France.
Abstract
BACKGROUND: Renal cancer accounts for 3% of adult malignancies; renal cell carcinoma (RCC) represents 80% of all renal cancers, and is characterized by late recurrences. Recurrences after kidney transplantation are associated with a high mortality rate. We aimed to determine if recurrences are linked to tumor characteristics and to delays between diagnosis and transplantation. METHODS: We retrospectively analyzed data from French kidney-transplanted patients with medical histories of pretransplant renal cancer, focusing on the most common histological subtypes: clear cell and papillary cancers. Characteristics of the tumors, patients, and kidney transplantations were documented, and posttransplant patient survival was analyzed. RESULTS: Of 143 patients, 13 experienced cancer recurrence after kidney transplantation. The mean delay in recurrence was 3 ± 2.3 years posttransplantation, and the cumulative incidences of recurrence were 7.7% at 5 years and 14.9% at 10 years. The risk of recurrence was higher in patients with clear cell RCC (13% vs 0%, P = 0.015). There was no correlation between posttransplant recurrence and the interval before transplantation. Factors associated with a higher risk of cancer recurrence were histological clear cell RCC (P = 0.025), tumor stage pT2 (P = 0.002), and Fuhrman grade IV (P < 0.001). Recurrences were associated with a high mortality rate; 76.9% of patients with recurrences had died by the end of the follow-up period. CONCLUSIONS: Recurrences of clear cell RCC are not uncommon after kidney transplantation and are associated with very poor prognoses. These results should be considered before listing patients with a history of renal cancer for transplantation.
BACKGROUND:Renal cancer accounts for 3% of adult malignancies; renal cell carcinoma (RCC) represents 80% of all renal cancers, and is characterized by late recurrences. Recurrences after kidney transplantation are associated with a high mortality rate. We aimed to determine if recurrences are linked to tumor characteristics and to delays between diagnosis and transplantation. METHODS: We retrospectively analyzed data from French kidney-transplanted patients with medical histories of pretransplant renal cancer, focusing on the most common histological subtypes: clear cell and papillary cancers. Characteristics of the tumors, patients, and kidney transplantations were documented, and posttransplant patient survival was analyzed. RESULTS: Of 143 patients, 13 experienced cancer recurrence after kidney transplantation. The mean delay in recurrence was 3 ± 2.3 years posttransplantation, and the cumulative incidences of recurrence were 7.7% at 5 years and 14.9% at 10 years. The risk of recurrence was higher in patients with clear cell RCC (13% vs 0%, P = 0.015). There was no correlation between posttransplant recurrence and the interval before transplantation. Factors associated with a higher risk of cancer recurrence were histological clear cell RCC (P = 0.025), tumor stage pT2 (P = 0.002), and Fuhrman grade IV (P < 0.001). Recurrences were associated with a high mortality rate; 76.9% of patients with recurrences had died by the end of the follow-up period. CONCLUSIONS: Recurrences of clear cell RCC are not uncommon after kidney transplantation and are associated with very poor prognoses. These results should be considered before listing patients with a history of renal cancer for transplantation.
Authors: Keun Hoi Park; Jung A Yoon; Hak Soo Kim; Hyosang Kim; Su-Kil Park; Young Hoon Kim; Bumsik Hong; Dalsan You; In Gab Jeong; Chung Hee Baek Journal: Kidney Res Clin Pract Date: 2019-12-31