Purpose: Renal Cell Carcinoma (RCC) has a high incidence in patients with acquired cystic kidney disease (ACKD) due to hemodialysis. It has been reported that these tumors are less aggressive in RCC patients with normal renal function. Graft and patient survival have increased considerably. Consequently, diagnosis of native kidney tumors that develop with normal renal function has become more frequent. We studied the clinical and pathologic outcomes of patients who developed RCC during dialysis and those who were diagnosed after transplantation. Groups were treated surgically for RCC in the native kidney.

Methods: Between January 1991 and December 2011, 2580 renal transplants were performed. Twenty-four patients underwent radical nephrectomy for a suspected renal mass in the native kidney. In 12 of these patients, the diagnosis and surgery were carried out prior to transplantation during the dialytic period (Group 1) and the remaining were carried out after transplantation (Group 2). In Group 2, 10 out of 12 patients with a suspected renal mass were confirmed to have RCC. One and 2 patients had bilateral disease in Group 1 and 2, respectively. This comprised 11 and 14 RCC in Groups 1 and 2, respectively.

Results: Demographic data were similar in both groups. The mean period from transplant and radical nephrectomy in Group 1 was 97.6± 75.55(2-254) months. The mean duration of dialysis was higher in Group 1 (48.5± 15.7vs 26.22± 21.98, p= 0.147) and also had a higher association with ACKD (78.57% vs 18%, p= 0.0048). We also observed a higher incidence of clear cell carcinoma in the dialytic group (92.7% vs 72.7%, p= 0.281). Papillary was present in 1 (Group 1) and 3 (Group 2) patients. Tumor multifocality occurred only in Group 2 (6 out of 14). There were no patients with nodal involvement or metastatic disease. The stage, Fuhrman grade, vascular invasion, necrosis, and size were similar in both groups. The mean follow up was 65.5± 42.31(8-156) months in Group 1 and 58± 42.51(2-145) months in Group 2.

Conclusions: Despite similar outcomes, it is clear that the renal masses that are acquired after renal transplantation have a different pathology than those acquired during dialysis. The low association with ACKD, low multiplicity and pathologic pattern are much more similar to normal kidney function tumors.

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