MEDtube Science 2015 - Renal cell carcinoma of native and allograft kidneys in renal transplant recipients

Malignancies following transplantation are more aggressive and developed at a more advanced stage than those in patients without transplants, and represent a significant cause of patient death following kidney transplantation. Renal cell carcinoma (RCC) is the most common urologic cancer in both native and transplanted kidneys among kidney recipients. RCC in the transplanted kidney can occur either as a de novo cancer or as a pre-existing occult cancer present in the donor kidney prior to transplantation. RCC of native kidneys and RCC of the kidney allograft can be distinguished, with more than 70% of the tumours occurring in the native kidneys. The risk of renal cell carcinoma development in renal transplant recipients is 15-100 times higher than in the general population. The most frequent subtype of RCC is renal clear cell carcinoma. The risk of developing RCC in native kidneys of renal transplant patients is increased in patients with acquired cystic kidney disease, in men, African-Americans, recipients aged at least 65 years, those with a longer pre-transplant dialysis interval, a donor aged at least 50 years, and microscopic haematuria. Risk factors of malignancy in renal transplant recipients directly associated with transplantation are immunosuppressant agents. The majority of RCC of native kidney in renal transplant recipients are asymptomatic and thus there is a possibility that the diagnosis may be delayed with poorer outcome. Surgery by partial nephrectomy, whenever feasible, or by radical nephrectomy is the standard of RCC care. Nephron-sparing surgery provides an optimal long-term oncologic efficacy in properly selected patients with localized renal cell carcinoma. Targeted therapy utilizing tyrosine kinase inhibitors and anti-VEGF antibodies is widely used in first- and second-line treatments of advanced RCC. Several investigators have reported that patients with cytokine-refractory metastatic RCC may have disease responses after reduced-intensity allogeneic hematopoietic stem cell transplantation. It has been established that RCC is susceptible to a GVT effect.