Due to the structural changes to the kidney that occur in polycystic kidney disease (PKD), imaging tests may not pick up pre-transplant renal cancers in these patients, and the incidence of pre-transplant malignancy is not clear. Risk of renal cell carcinoma in patients with chronic kidney disease, including PKD, has been linked to time on dialysis.

Methods: Our transplant center frequently performs simultaneous native nephrectomy and kidney transplantation for patients with symptomatic PKD. We reviewed the pathology reports of the nephrectomy specimens to determine the rate of incidental malignancy, and report on the outcome of patients diagnosed with malignancy at the time of transplant. Only patients receiving a first transplant and no prior history of renal malignancy were included to reduce confounding factors.

Results: Seventy-one patients underwent simultaneous native nephrectomy (61 bilateral and 10 single) and living donor kidney transplantation between 1/1/07 and 7/31/17. Mean age was 51 ± 9 years; 66 were Caucasian (93%); the majority of patients were transplanted prior to going on dialysis (n=53; 74.6%). Three of 71 patients (4.2%) had a malignancy removed on the day of transplant: histologic examination revealed that 3 of 132 kidneys (2.3%) had a diagnosis of carcinoma (1 clear cell, 2 tubulopapillary). Due to the small number of patients, formal statistical analysis was not performed, however, mean age of the patients with malignancy was 68 ± 9 years, all patients received a pre-emptive transplant and 2 had a history of smoking. Two received basiliximab induction while the other received rATG. With a mean of 2.7 years of post-transplant follow-up, none of the 3 patients have been diagnosed with post-transplant malignancy.

Conclusions: Unrecognized pre-transplant renal cancers occur in about 4% of patients with symptomatic PKD undergoing simultaneous native nephrectomy and kidney transplantation, and occur prior to the need for dialysis. Further research is needed to elucidate whether advanced age and other factors can help to identify patients at higher risk.

CITATION INFORMATION: Aull M., Del Pizzo J., Watkins A., Kapur S. Pre-Existing Renal Cell Carcinomas in Patients with Polycystic Kidney Disease Undergoing Simultaneous Native Nephrectomy and Living Donor Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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