Screen kidney transplant recipients for renal cancer after transplantation, surgeons say

John Murphy, MDLinx | October 26, 2017

Up to 10% of kidney transplant recipients may go on to develop renal cell carcinoma (RCC) after transplantation, according to a study performed by kidney transplant surgeons that was recently published in Transplantation Proceedings.

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Don't take a pass on a renal mass

Ultrasound of renal mass suspicious for renal cell carcinoma. (Image: Karl Marzec, MD, Thomas Mailhot, MD, Phillips Perera, MD; CC BY 3.0)

“As a result of our data, we recommend and have instituted annual ultrasound screening of native kidneys in all renal transplant patients,” wrote the study’s authors, led by William M. Bennett, MD, medical director of transplantation and director of renal research, Legacy Good Samaritan Medical Center, Portland, OR.

Because patients with end-stage renal disease (ESRD) have a higher risk for cancer, kidney transplant candidates are routinely and carefully screened for malignancy before transplantation. But there are no standard guidelines for RCC screening in transplant recipients after transplantation, the surgeons noted.

“We re-evaluated our screening practice due to a notable case?a pre-transplant patient with a negative ultrasound who presented with widespread, metastatic RCC less than 1 year post-transplant,” Dr. Bennett and colleagues explained.

For this study, the transplant surgeons performed prospective retroperitoneal ultrasound on 135 new kidney transplant recipients from 2013 to 2015. The ultrasounds were performed during routine 6-month and 1-year postoperative appointments.

Of these 135 patients, 18 (13.3%) had ultrasounds identified as abnormal. Of these, 14 (10.4%) were categorized as acquired cystic disease (ACD), and 4 (2.9%) revealed solid lesions. Histological analysis confirmed that three of these solid lesions were RCC, while the remaining one was a benign inflammatory mass in a patient who had RCC prior to transplantation.

In addition, the surgeons also retrospectively reviewed 56 ultrasounds done at outside nephrology centers before 2013. Of these, 6 of 56 (10.7%) had lesions that were determined to be RCC.

“Malignancy post-renal transplant is a common cause of death,” Dr. Bennett and colleagues wrote. “We argue that early detection and treatment of RCC through routine screenings of kidney transplant recipients is best practice.”

Computed tomography may be a more effective screening method, they acknowledged, but they chose ultrasound because it’s easily available, noninvasive, relatively inexpensive, and could save lives.

“Our data,” they concluded, “suggest that a targeted screening program may prevent late-stage renal cancers from going undetected in renal transplant recipients.”

Based on the results of their small study, the surgeons recommend that larger, more robust studies be performed to determine best practices for RCC screening to improve post-transplant outcomes.

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