67th Annual Meeting Abstracts
Native Nephrectomy for Renal Cell Carcinoma in Transplant Recipients
*Kristina D Suson, *Justin E. Sausville, *Alp Sener, Michael W. Phelan
University of Maryland Medical Center, Baltimore, MD
Introduction - Renal cancer is one of the top ten causes of cancer death among adults in the United States. Dialysis and acquired cystic kidney disease (ACKD) increase the risk of renal cell carcinoma (RCC). This risk continues after transplantation. We report our experience in 15 post-transplant patients who underwent native nephrectomy for renal masses.
Materials & Methods - IRB-exempt retrospective chart review was performed on transplant recipients who underwent native nephrectomy for suspicious masses.
Results - Twenty-two kidneys were removed from 15 patients, 18 laparoscopically and 4 open. Seventeen units (77%) from 13 patients contained RCC. One kidney had two cancers, for a total of 18 cancers. The distribution of RCC follows: 11 papillary, 4 clear cell, and 3 chromophobe. Most patients were low stage: 10 stage T1N0M0, 2 stage T2N0M0, and 1 stage T3N0M0. The median length of stay (LOS) for laparoscopic nephrectomy was 61 hours. Open bilateral nephrectomies for masses within polycystic kidneys were performed on two patients, with an 18 day average LOS. Complications (20%) included a delayed extraction site hernia, bronchitis, and bacteremia. There were no episodes of rejection, dialysis or injury to the kidney. No patients have recurred, with an average followup of 36 months.
Conclusions - Renal transplant recipients can safely undergo native nephrectomy without jeopardizing their grafts. The cancers may be found at an earlier stage because of frequent imaging of transplant recipients. Immunosuppression does not seem to promote metastasis or recurrence, although longer followup is required.
