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Review
. 2022 Jan 1;106(1):e52-e63.
doi: 10.1097/TP.0000000000003762.

Renal Cell Carcinoma and Kidney Transplantation: A Narrative Review

Dag Olav Dahle  1 , Morten Skauby  1 , Carl Wilhelm Langberg  2 , Knut Brabrand  3 , Nicolai Wessel  4 , Karsten Midtvedt  1
Affiliations
Review

Renal Cell Carcinoma and Kidney Transplantation: A Narrative Review

Dag Olav Dahle et al. Transplantation. .

Abstract

Kidney transplant recipients (KTRs) are at increased risk of developing renal cell carcinoma (RCC). The cancer can be encountered at different steps in the transplant process. RCC found during work-up of a transplant candidate needs treatment and to limit the risk of recurrence usually a mandatory observation period before transplantation is recommended. An observation period may be omitted for candidates with incidentally discovered and excised small RCCs (<3 cm). Likewise, RCC in the donor organ may not always preclude usage if tumor is small (<2 to 4 cm) and removed with clear margins before transplantation. After transplantation, 90% of RCCs are detected in the native kidneys, particularly if acquired cystic kidney disease has developed during prolonged dialysis. Screening for RCC after transplantation has not been found cost-effective. Treatment of RCC in KTRs poses challenges with adjustments of immunosuppression and oncologic treatments. For localized RCC, excision or nephrectomy is often curative. For metastatic RCC, recent landmark trials in the nontransplanted population demonstrate that immunotherapy combinations improve survival. Dedicated trials in KTRs are lacking. Case series on immune checkpoint inhibitors in solid organ recipients with a range of cancer types indicate partial or complete tumor response in approximately one-third of the patients at the cost of rejection developing in ~40%.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Flowchart of literature search. For Supplemental Digital Content please refer to http://links.lww.com/TP/C193. ACKD, acquired cystic kidney disease; RCC, renal cell carcinoma.
FIGURE 2.
FIGURE 2.
Epidemiology of RCC in kidney transplant recipients. A, Time to RCC, by history of renal cyst. Adapted from Hurst et al with permission. B, Risk of local or regional/distant RCC after kidney transplant. Vertical axis shows hazard in units of “per 1000 person-y.” Adapted from Karami et al with permission. C, Survival after diagnosis of RCC in allograft, by size of tumor. Adapted from Tillou et al with permission. RCC, renal cell carcinoma.
FIGURE 3.
FIGURE 3.
Overview of recommendations. Please refer to Table 3 for details.
See this image and copyright information in PMC

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MeSH terms