Tumour in the renal graft after transplantation
Kiss Zoltán dr., Berczi Csaba dr., Berczi Adrienne, Flaskó Tibor dr.
Debreceni Egyetem Általános Orvostudományi Kar, Urológiai Tanszék, Debrecen (igazgató: Flaskó Tibor dr.)
Introduction: The administered immunosuppressive treatment increases the incidence of malignant tumours after organ transplantation. Occurrence of renal cancers is higher after kidney transplantation than in normal population. These tumours mainly occur in the own kidney of the recipients, while in 10% they developed in the graft. The authors report their experience with treatment of tumour in renal graft in their three cases.
Case presentation: Case 1: Kidney transplantation was performed 20 years ago in a 46-year-old male patient. The routine ultrasound examination showed a 2 cm tumour in the graft which was confirmed by the abdominal MR scan. The patient underwent partial nephrectomy. Histology proved pT1a, renocellular carcinoma. The dose of immunosuppressive drugs was reduced after surgery. No recurrence was observed in the 2-year follow-up period.
Case 2: Renal transplantation was done 13 years ago in a 65-year-old female patient. Ultrasound and CT scan of the graft described a 35 mm tumour at the upper pole of the kidney. Partial nephrectomy was performed. Histological examination showed pT1a, renocellular carcinoma. Following surgery, the dose of immunosuppressive drugs was reduced. There was no tumour recurrence during the 17 months’ follow-up.
Case 3: In the 62-year-old male patient, kidney transplantation was carried out 10 years earlier. During the follow-up, the ultrasound showed a 2.5 cm tumour in the graft, which was confirmed by CT. Partial resection was performed and a multifocal tumour was removed. The histology proved papillary carcinoma. Following surgery, everolimus treatment was started instead of tacrolimus. There was no tumor recurrence during the 2 months follow-up.
Discussion: After kidney transplantation, in case with tumour in the renal graft organ sparing surgery is recommended. In the described cases, tumour resection was also performed. The organ sparing surgery provides adequate oncological efficacy with preservation the function of the transplanted kidney.