Surgical Management of Renal Cell Carcinoma in Transplanted Kidneys—A Narrative Review
Simple Summary
Abstract
1. Introduction
2. Materials and Methods
3. Epidemiology
4. Risk Factors
Risk Factors Category | Details | Risk Level/Statistics |
---|---|---|
Immunosuppression | • Azathioprine and Cyclosporine [2] • Cumulative dose-dependent effect observed [2,3] | ↑ Malignancy risk with cumulative doses [2,3]: Mycophenolate: ↑ risk in female patients Tacrolimus: Long-term exposure ↑ risk in young males |
Donor-Derived Malignancies | Deceased donor transplants show higher incidence of RCC [34,35] | 74.2% Deceased donors vs 25.8% Living donors [34,35] |
ESKD | Independent risk factor for RCC [24,25] | 3.6× ↑ Risk of RCC vs. non-ESKD patients [1] |
Cause of ESKD | Higher Risk: • Vascular disease • Glomerular disease • Hypertensive nephrosclerosis Lower Risk: • Diabetes • Polycystic kidney disease | Risk depending on underlying etiology [1] |
ACKD | • 60% at 2–4 years of dialysis • 90% at >8 years of dialysis [46,47] | 20% of patients with ACKD will develop RCC [1] |
Time Interval from Transplant | • RCC occurrence ranges widely post-transplant [35,40,41,42] | 9–312 months post-transplant [35,40,41,42] (2-year cutoff for donor transmission under debate—DNA tests to confirm donor-derived origin [36]) |
5. Surgical Approach in RCC in Transplanted Kidneys
6. Pathology Findings
7. Alternatives to Surgery
8. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Treatment Option | Description | Advantages | Limitations | Outcomes |
---|---|---|---|---|
Open Nephron-Sparing Surgery (NSS) | Surgical procedure preserving kidney function for T1a tumors (<4 cm). [4,16,20,35,48] | ↑ Oncological outcomes ↑ Renal function [4,16,20,35,48] | ↑ Surgical complexity [49] | Local recurrence: 3.6–6% [34,50] |
LPN, RAPN, NSS | Surgical alternatives. | ↓ Blood loss ↑ Functional outcomes [51] ↓ Complications (RAPN) [9] | ↑ Ischemia time (LPN) [51] ↑ Operative time [51] ↑ PSM [51] | Comparable oncological outcomes among LPN, OPN, RAPN [9] |
Ablation Techniques | Minimally invasive techniques: • Radiofrequency ablation • Cryoablation | Preserves renal function Less invasive procedure Repeatable if necessary [52,53] | No definitive histology ↑ Treatment failures + Smaller lesions [52,53] Close follow-up [52,53] | ↑ Efficacy for T1a tumors [52,53] ↓ Local control rates for T1b [52,53] |
Active Surveillance | Monitoring small, low-growth tumors without immediate intervention. [52,53] | pRCC—low risk of progression [52,53] | Requires intensive follow-up ↑ Disease progression [54,55,56] | No data available |
Radical Nephrectomy | Standard treatment for larger tumors (>4 cm) or complex cases where NSS is not feasible. [52,53] | Complete tumor removal | ↑ Risk of cardiovascular mortality [52,53] Loss of kidney function Return to dialysis | ↑ Oncological outcomes [52,53] ↑ Complication risk [52,53] |
Systemic Therapy (Immunotherapy, TKIs) | Treatment for metastatic RCC including ICIs and TKIs. [57,58] | Especially effective with ICIs [57,58] | ↑ Risk of graft rejection Limited data on RCC outcomes in transplant patients [57,58] | ↑ OS [57,58] Promising results from limited data [57,58] |
Allograft RCC Staging System | |
---|---|
T1—tumors equal to or less than 7 cm confined to the kidney | T1a tumors: ≤4 cm T1b tumors: >4 cm but <7 cm |
T2—tumors that exceed 7 cm while still being confined to the kidney | |
T3—tumors are defined by extension into major veins or invasion of renal sinus fat or peritoneum | T3a: Tumors that invade renal sinus fat or peritoneum T3b: Tumors invading the external iliac vein or common iliac vein T3c: Tumors that invade the inferior vena cava |
T4—tumors that invade surrounding perinephric organs, such as the psoas muscle, walls of the iliac vessels, bladder, small intestine and colon |
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Moldoveanu, O.; Baston, C.; Preda, A.T.; Sorohan, B.; Stoica, R.; Mirvald, C.; Sinescu, I. Surgical Management of Renal Cell Carcinoma in Transplanted Kidneys—A Narrative Review. Cancers 2025, 17, 1864. https://doi.org/10.3390/cancers17111864
Moldoveanu O, Baston C, Preda AT, Sorohan B, Stoica R, Mirvald C, Sinescu I. Surgical Management of Renal Cell Carcinoma in Transplanted Kidneys—A Narrative Review. Cancers. 2025; 17(11):1864. https://doi.org/10.3390/cancers17111864
Chicago/Turabian StyleMoldoveanu, Oana, Cătălin Baston, Adrian Traian Preda, Bogdan Sorohan, Robert Stoica, Cristian Mirvald, and Ioanel Sinescu. 2025. "Surgical Management of Renal Cell Carcinoma in Transplanted Kidneys—A Narrative Review" Cancers 17, no. 11: 1864. https://doi.org/10.3390/cancers17111864
APA StyleMoldoveanu, O., Baston, C., Preda, A. T., Sorohan, B., Stoica, R., Mirvald, C., & Sinescu, I. (2025). Surgical Management of Renal Cell Carcinoma in Transplanted Kidneys—A Narrative Review. Cancers, 17(11), 1864. https://doi.org/10.3390/cancers17111864