Surgical treatment of renal cell carcinoma in the immunocompromised transplant patient.

Objectives: 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.