Surgical treatment of renal cell carcinoma in the immunocompromised transplant patient.
OBJECTIVE
To determine whether iatrogenic immunosuppression used after transplantation infers a poor prognosis of renal cell carcinoma (RCC) as natural negative immune regulators have been associated with decreased cancer-specific survival from RCC.


METHODS
All patients with a solid organ transplant who underwent radical nephrectomy or nephron-sparing surgery for nonhereditary sporadic RCC from 1970 to 2003 were identified and retrospectively reviewed.


RESULTS
We identified 17 patients with surgically treated rcc who also underwent a solid organ transplant: 11 with transplant before RCC and 6 with transplant after RCC. Type of transplant included 9 kidney, 3 heart, 3 liver, 1 kidney and liver, and 1 kidney and pancreas. Tumor pathology included 10 clear-cell RCC and 7 papillary RCC. At the last follow-up 6 patients died at a mean of 5.9 years after nephrectomy. Among the 11 patients still alive, mean follow-up was 7.6 years. Only 1 patient died of RCC. This patient had metastatic clear-cell RCC that was completely resected 8 years before renal transplant. He had a recurrence 2 years post transplant and died 3 years after recurrence. No other patients experienced local or distant disease recurrence. Immunosuppression was decreased in only 2 patients; one secondary to RCC metastases and another for recurrent skin cancer.


CONCLUSIONS
Surgical resection of RCC in transplant patients is associated with a low rate of progression, despite optimal immunosuppression. We recommend surgical resection of low-risk, organ-confined RCC without reduction in immunosuppression in patients with solid organ transplants.
Tollefson
Matthew K
MK
Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 55905, USA. tollefson.matthew@mayo.edu
Krambeck
Amy E
AE
Leibovich
Bradley C
BC
Blute
Michael L
ML
Chow
George K
GK
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000276:immunology* / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D016027:Heart Transplantation / Q000276:immunology / Q000379:methods; D006801:Humans; D016867:Immunocompromised Host; D007680:Kidney Neoplasms / Q000276:immunology* / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology / Q000379:methods; D016031:Liver Transplantation / Q000276:immunology / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; D016377:Organ Transplantation / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014181:Transplantation Immunology / Q000502:physiology