title: Trends in management of the small renal mass in renal transplant recipient candidates: A multi-institutional survey analysis.
abstract: Patients with end-stage renal disease are under increased risk for renal cell carcinoma development, and radical nephrectomy is the preferred treatment in this setting. Owing to the increased surgical morbidity and mortality, active surveillance (AS) may be a valid option for treatment of small renal masses (SRM). As there is a lack of high-level evidence for treatment recommendations, we performed a survey analysis to analyze the treatment patterns of transplant surgeons.
  
  
  
  A 21-question online survey designed to analyze the practice patterns to treat SRM in renal transplant recipient candidates was sent to active transplant centers in the United States. The list of recipients to whom the survey was distributed was obtained with permission from the American Society of Transplant Surgeons.
  
  
  
  We received 62 responses. All regions of United Network of Organ Sharing were represented. Radical nephrectomy was the preferred treatment (59%, n = 61), followed by AS (21.3%, n = 13), partial nephrectomy (14.8%, n = 9), and focal ablative therapy (4.9%, n = 3). Among the responders whose institutions did not allow AS, 77.4% indicated that if presented with long-term data showing safety of AS, they would perform immediate transplantation and monitor SRM. Responders were more likely to allow immediate transplantation after radical nephrectomy (77.4%), as opposed to partial nephrectomy (58.1%) and focal ablation (45.2%).
  
  
  
  Though radical nephrectomy is the preferred treatment, most transplant surgeons would consider AS if long-term safety data were available.
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Alp Tuna
authors.initials: AT
authors.lastname: Beksac
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: David J
authors.initials: DJ
authors.lastname: Paulucci
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: John P
authors.initials: JP
authors.lastname: Sfakianos
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Balaji N
authors.initials: BN
authors.lastname: Reddy
authors.affiliation: Department of Urology, VA Long Beach Healthcare System, Long Beach, CA.
authors.forename: Greg E
authors.initials: GE
authors.lastname: Gin
authors.affiliation: Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Lerner
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: ketan.badani@mountsinai.org.
authors.forename: Ketan K
authors.initials: KK
authors.lastname: Badani
mesh_terms: D003430:Cross-Sectional Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D007680:Kidney Neoplasms / Q000150:complications / Q000628:therapy*; D016030:Kidney Transplantation; D009392:Nephrectomy / Q000379:methods; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D066027:Transplant Recipients; D057832:Watchful Waiting