*Purpose: Incidence of urologic tumors is increased in renal transplant recipients. In case of a kidney transplant neoplasm, the graft-nephrectomy and hemodialysis reduce the quality of life. Partial nephrectomy may preserve renal function. The aim was to report our retrospective case series.

*Methods: Fifteen patients with mean age 60±14 years (24-80 years) and mean time after kidney transplantation 10±6 years (2.5 months-18 years) were diagnosed with allograft neoplasm by routine screening between 1/2014-11/2019. They were treated with partial nephrectomy.

*Results: Renal functions before resection: mean creatinine (Cr) level 136±48 µmol/l and mean estimated glomerular filtration rate (eGFR) 0.86±0.46 ml/min. All patients suffered from transitory significant impairment of renal function postoperatively on day 5: Cr=186±59 µmol/l (+35%, p=0.02). However, mean Cr level on day 7 decreased to near pre-operative level: Cr=159±61 µmol/l (+16%, p=0.16). Five patients received temporary nephrostomy peri-operatively. Hospital stay lasted 10±5 days (5-22 days). Post-operative complications Clavien grade II occurred 2× (urinary tract infection), grade IIIa 1× (urinary leak drainage). Otherwise the recovery was uneventful. Renal functions at 6 months: Cr=158±62 µmol/l, (+15%, p=0.10, n.s.), eGFR=0.74±45 ml/min (-13%, p=0.26, n.s.). Histology showed pT1a renal cell carcinoma 5×, urothelial carcinoma 8×, collecting duct carcinoma 1× and cortical cyst 1×. No adjuvant oncologic therapy was needed. Immunosuppression was modified 2×. Four patients died 2.0±1.1 years (1.4-3.6 years) after graft resection of unrelated causes. One graft was explanted due to terminal function and infection 1 year after the resection. The remaining 9 patients survived tumor free with functioning graft to date (3.4±1.8 years, 1.2-5.9 years).

*Conclusions: Partial nephrectomy of renal allograft is a feasible approach for tumor removal with full preservation of graft function and favorable oncologic outcome. It should be offered to all patients in whom it is clinically relevant. Supported by Ministry of Health of the Czech Republic, grant nr. 18-02-00422, 19-02-00068. All rights reserved.

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