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67th Annual Meeting Abstracts
Radical Nephrectomy for Renal Cell Carcinoma before Renal Transplantation
*Kristina D Suson, *Justin E Sausville, *Alp Sener, Michael W Phelan
University of Maryland Medical Center, Baltimore, MD
Introduction - Traditionally patients with cancer are observed for at least two years after treatment before considered eligible for transplantation. However, for non-invasive low-grade cancers, the risk of death from renal failure may exceed that of the cancer. We present nine patients who had nephrectomies for RCC and subsequently received a renal transplant.
Materials & Methods - IRB-exempt retrospective chart review was performed on patients with RCC who subsequently received a renal transplant.
Results - Eleven renal units were removed from nine patients; all were attempted laparoscopically with one conversion to open. Eleven malignancies were found within 10 kidneys. All patients had stage T1N0M0 RCC: five papillary, five clear cell and one cystic. Tumor grade was known for 10 of the 11 masses: eight Furhman grade 2 and two Furhman grade 3. The average length of stay following nephrectomy was 55 hours. The two surgical complications (22%) included one delayed extraction site hernia and one dehiscence. The median time to transplant after nephrectomy was 5 months. The two Furhman grade 3 patients were observed 24 and 29 months before transplant. At an average followup of 29 months, no patients have recurred.
Conclusions - It may be safe to transplant selected patients with low stage, low grade RCC without the traditional two years of observation. Although papillary RCC is the most common histology in dialysis patients, our patients were just as likely to develop clear cell carcinoma. Subsequent immunosuppression does not appear to increase the risk of recurrence.
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