Detection and management of renal cell carcinoma in the renal allograft

Tumours of the transplanted kidney represent a rare form of post-transplantation malignancies. An important aspect of the treatment option is whether the transplanted kidney can be saved or not. Aim of our study was the analysis of our allograft tumours. In the Budapest Centre, 3,530 kidney transplantations were performed between 1973 and 2012. Retrospective analysis of 9 patients who developed renal cell carcinoma (RCC) in the transplanted kidney was done. Mean age of recipients was 45.3 +/- A 13.4 years at the time of transplantation and 57.0 +/- A 11.6 years at the time of tumour detection. Mean age of their donors was 43.5 +/- A 11.5 years. Mean time from transplantation to tumour diagnosis was 134.6 +/- A 40.8 months. Seven RCC were stage pT1a, 1 was stage pT1b and 1 was pT3a. Eight patients had stage I. (pT1a-b, N0, M0) and 1 patient had stage IV. (pT3a, N1, M1) disease. Histological types were clear cell (n = 6), papillary (n = 2) and sarcomatoid (n = 1) carcinomas. The tumour growth rate of RCC was 16.7 +/- A 13.5 mm/year. In 4 cases, transplant nephrectomy was performed; 5 cases had percutaneous radiofrequency ablation (RFA). Ablative therapy had no influence on renal graft function. Six patients (including 5 patients who were treated with RFA) are still alive and tumour-free; 3 patients died. According to our observation, we can state that RCC of the kidney allograft diagnosed at an early stage can be successfully treated with RFA instead of graft removal. A longer follow-up is needed to assess the effectivity of the RFA treatment in these cases.