Advertisement

Frequency and Predictors of Renal Transplantation Among Patients Rendered Surgically Anephric for Sporadic Renal Cancer

Published:January 14, 2019DOI:https://doi.org/10.1016/j.urology.2018.12.037

      Abstract

      Objective

      To assess the frequency of renal transplantation in patients rendered surgically anephric during treatment of renal cancers as well as the clinicopathologic factors associated with receipt of transplantation.

      Methods

      A retrospective review was conducted to identify patients rendered surgically anephric between 2001 and 2016 due to cancer in both renal units or cancer in an anatomically or functionally solitary kidney. Patient demographics, comorbidities, and cancer features were compared between patients who subsequently received a renal transplantation and those who did not. Time-to-event analysis was used to compare time to transplantation across varied identified parameters.

      Results

      Among 27 patients rendered anephric, 4 (15%) received a renal transplantation over a median follow-up of 21.6 months (interquartile range 7.2, 53.3). All transplanted patients were less than 70 years of age and had cT1a renal parenchymal mass at the time of nephrectomy. No patient undergoing completion nephrectomy for upper tract urothelial carcinoma received transplantation. Patients who were evaluated by the transplant service prior to nephrectomy were more likely to eventually undergo transplantation (60% vs 5%; P < .01). On time-to-event analyses, a cT1a renal parenchymal mass (P < .01) and a pre-nephrectomy transplant evaluation (P < .01) were associated with receipt of a transplant.

      Conclusion

      Patients rendered anephric via nephrectomy for cancer are more likely to receive renal transplantation if they are less than 70 years old, have a cT1a renal parenchymal mass, and receive transplant consultation before nephrectomy. These data may inform future patient counseling.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lewis D.R.
        • Chen H.S.
        • Cockburn M.E.
        • et al.
        Early estimates of SEER cancer incidence, 2014.
        Cancer. 2017; 123: 2524-2534
        • Adkins K.L.
        • Chang S.S.
        • Cookson M.S.
        • et al.
        Partial nephrectomy safely preserves renal function in patients with a solitary kidney.
        J Urol. 2003; 169: 79-81
        • Saranchuk J.W.
        • Touijer A.K.
        • Hakimian P.
        • et al.
        Partial nephrectomy for patients with a solitary kidney: the Memorial Sloan-Kettering experience.
        BJU Int. 2004; 94: 1323-1328
        • Fergany A.F.
        • Saad I.R.
        • Woo L.
        • et al.
        Open partial nephrectomy for tumor in a solitary kidney: experience with 400 cases.
        J Urol. 2006; 175: 1630-1633
        • Thompson R.H.
        • Lane B.R.
        • Lohse C.M.
        • et al.
        Renal function after partial nephrectomy: effect of warm ischemia relative to quantity and quality of preserved kidney.
        Urology. 2012; 79: 356-360
        • Denker M.
        • Boyle S.
        • Anderson A.H.
        • et al.
        Chronic renal insufficiency cohort study (CRIC): overview and summary of selected findings.
        Clin J Am Soc Nephrol. 2015; 10: 2073-2083
        • Ortiz A.
        • Covic A.
        • Fliser D.
        • et al.
        Epidemiology, contributors to, and clinical trials of mortality risk in chronic kidney failure.
        Lancet. 2014; 383: 1831-1843
        • Kasiske B.L.
        • Ramos E.L.
        • Gaston R.S.
        • et al.
        The evaluation of renal transplant candidates: clinical practice guidelines.
        Clin J Am Soc Nephrol. 1996; 6: 1-34
        • Knoll G.
        Trends in kidney transplantation over the past decade.
        Drugs. 2008; 68: 3-10
        • Burns T.
        • Fernandez R.
        • Stephens M.
        The experiences of adults who are on dialysis and waiting for a renal transplant from a deceased donor: a systematic review.
        JBI Database System Rev Implement Rep. 2015; 13: 169-211
        • Charlson M.E.
        • Pompei P.
        • Aless K.L.
        • et al.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Levey A.S.
        • Coresh J.
        • Greene T.
        • et al.
        Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate.
        Ann Intern Med. 2006; 145: 247-254
        • Miskulin D.C.
        • Martin A.A.
        • Brown R.
        • et al.
        Predicting 1 year mortality in an outpatient haemodialysis population: a comparison of comorbidity instruments.
        Nephrol Dial Transplant. 2004; 19: 413-420
      1. The Nephron Information Center. Available at: http://nephron.org/cgi-bin/rpa_sdm.cgi. Accessed: April 17, 2017.

        • Reinberg Y.
        • Matas A.
        • Manivel C.
        • et al.
        Outcome of renal transplantation or dialysis in patients with a history of renal cancer.
        Cancer. 1992; 70: 1564-1567
        • Goldfarb D.A.
        • Neumann H.P.
        • Penn I.
        • et al.
        Results of renal transplantation in patients with renal cell carcinoma and von Hippel-Lindau disease.
        Transplantation. 1997; 64: 1726-1729
        • Steinbach F.
        • Novick A.C.
        • Shoskes D.
        Renal transplantation in patients with renal cell carcinoma and von Hippel-Lindau disease.
        Urology. 1994; 44: 760-763
        • Wiggins C.
        • Pontin A.R.
        • Manas D.
        • et al.
        Renal transplantation in patients with bilateral renal carcinoma—how long should we wait?.
        Transpl Int. 1993; 6: 348-349
        • Penn I.
        Kidney transplantation in patients previously treated for renal carcinomas.
        Transpl Int. 1994; 6: 350
        • Lane B.R.
        • Campbell S.C.
        • Demirjian S.
        • et al.
        Surgically induced chronic kidney disease may be associated with a lower risk of progression and mortality than medical chronic kidney disease.
        J Urol. 2013; 189: 1649-1655
        • Nguyen K.A.
        • Vourganti S.
        • Syed J.S.
        • et al.
        End-stage renal disease secondary to renal malignancy: epidemiologic trends and survival outcomes.
        Urol Oncol. 2017; 35: 529.e1-529.e7