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Recurrence of Renal Cell Cancer After Renal Transplantation in a Multicenter French Cohort

Cognard, Noelle, MD1; Anglicheau, Dany, MD, PhD2; Gatault, Philippe, MD, PhD3; Girerd, Sophie, MD, MSc4; Essig, Marie, MD, PhD5; Hurault de Ligny, Bruno, MD, PhD6; Le Meur, Yann, MD, PhD7; Le Roy, Franck, MD8; Garrouste, Cyril, MD9; Thierry, Antoine, MD, PhD10; Colosio, Charlotte, MD11; Rivalan, Joseph, MD12; Sayegh, Johnny, MD13; Choukroun, Gabriel, MD, PhD14; Moulin, Bruno, MD, PhD1; Caillard, Sophie, MD, PhD1

doi: 10.1097/TP.0000000000002009
Original Clinical Science—General

Background Renal cancer accounts for 3% of adult malignancies; renal cell carcinoma (RCC) represents 80% of all renal cancers, and is characterized by late recurrences. Recurrences after kidney transplantation are associated with a high mortality rate. We aimed to determine if recurrences are linked to tumor characteristics and to delays between diagnosis and transplantation.

Methods We retrospectively analyzed data from French kidney-transplanted patients with medical histories of pretransplant renal cancer, focusing on the most common histological subtypes: clear cell and papillary cancers. Characteristics of the tumors, patients, and kidney transplantations were documented, and posttransplant patient survival was analyzed.

Results Of 143 patients, 13 experienced cancer recurrence after kidney transplantation. The mean delay in recurrence was 3 ± 2.3 years posttransplantation, and the cumulative incidences of recurrence were 7.7% at 5 years and 14.9% at 10 years. The risk of recurrence was higher in patients with clear cell RCC (13% vs 0%, P = 0.015). There was no correlation between posttransplant recurrence and the interval before transplantation. Factors associated with a higher risk of cancer recurrence were histological clear cell RCC (P = 0.025), tumor stage pT2 (P = 0.002), and Fuhrman grade IV (P < 0.001). Recurrences were associated with a high mortality rate; 76.9% of patients with recurrences had died by the end of the follow-up period.

Conclusions Recurrences of clear cell RCC are not uncommon after kidney transplantation and are associated with very poor prognoses. These results should be considered before listing patients with a history of renal cancer for transplantation.

Recurrences of renal cell carcinoma after kidney transplantation are common with 15% incidence and are associated with very poor prognoses. These results should be considered before listing patients with a history of renal cancer for transplantation.

1 Nephrology-Transplantation Department, University Hospital, Strasbourg, France.

2 Department of Nephrology and Kidney Transplantation, Necker Hospital, Paris, France.

3 Department of Nephrology and Clinical Immunology, CHRU and FHU Transplantation, Tours, France.

4 Department of Nephrology, University Hospital, Nancy, France.

5 Department of Nephrology, University Hospital, Limoges, France.

6 Department of Nephrology, University Hospital, Caen, France.

7 Department of Nephrology, University Hospital, Brest, France.

8 Department of Nephrology, University Hospital, Rouen, France.

9 Department of Nephrology, University Hospital, Clermont-Ferrand, France.

10 Department of Nephrology, University Hospital, Poitiers, France.

11 Department of Nephrology, University Hospital, Reims, France.

12 Department of Nephrology, University Hospital, Rennes, France.

13 Department of Nephrology, University Hospital, Angers, France.

14 Department of Nephrology, University Hospital, Amiens, France.

Received 5 May 2017. Revision received 6 October 2017.

Accepted 7 October 2017.

The authors declare no funding or conflicts of interest.

N.C. collected the data, performed research, analyzed data, and contributed to the writing and revision of the article. D.A. collected data and contributed to the revision of the article. P.G. collected data and contributed to the revision of the article. S.G. collected data and contributed to the revision of the article. M.E. collected data and contributed to the revision of the article. B.H.d.L. collected data and contributed to the revision of the article. Y.L.M. collected data and contributed to the revision of the article. F.L.R. collected the data and contributed to the revision of the article. C.G. collected the data and contributed to the revision of the article. A.T. collected data and contributed to the revision of the article. C.C. collected data and contributed to the revision of the article. J.R. collected data and contributed to the revision of the article. J.S. collected data and contributed to the revision of the article. G.C. collected data and contributed to the revision of the article. B.M. contributed to the designing of the study and revision of the article. S.C. designed the study, performed research, collected data, analyzed data, and contributed to the writing and revision of the article. All authors approved the final version of the article.

Correspondence: Noëlle Cognard, MD, University Hospital, Nephrology-Transplantation Department, Nouvel Hôpital Civil, 1, Place de l’Hôpital, 67000 Strasbourg, France, (Noelle.cognard@chru-strasbourg.fr).

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