Login to Access Video or Poster Abstract: MP74-09
Sources of Funding: None

Introduction

Renal transplantation is the gold-standard treatment for end-stage renal disease (ESRD). It is known that transplant patients are at an increased risk of developing de-novo malignancy, with initial evidence showing an increased risk of solid renal masses (SRMs) in the transplant allograft kidney compared to the overall population. Definitive management of SRMs in transplanted allograft kidneys is a difficult clinical scenario due to complex surgical anatomy, postoperative adhesions, and need for renal preservation. The aim of this study was to review a single institutional experience with focal ablative therapies for SRMS in transplant allograft kidneys.

Methods

After institutional review board approval, patients with a history of SRM in transplanted allograft kidneys who underwent focal ablative therapy were identified. Complete chart review was performed with relevant data extracted for cumulative analysis.

Results

Five patients treated with focal ablative therapy of a SRM in a transplanted allograft kidney were identified from 2010-2015 at our institution. Two underwent percutaneous microwave ablation, one percutaneous irreversible electroporation ablation, one laparoscopic cryoablation, and one open cryoablation. Median mass size was 2.8cm (range 1.6-3.4cm). SRMs were diagnosed at a median of 96 months (range 1-96 months) after transplantation, with three patients having undergone living donor transplantation and two receiving cadaveric grafts. Tumor histology included 3 clear cell renal cell carcinoma (RCC), 1 papillary RCC, and 1 had no available pathology. One mass had a Furhman grade of 3 and the other three available histologies were classified as Fuhrman grade 1-2. Two patients experienced postoperative complications, with one patient developing a hematoma requiring drainage (Clavien IIIa), and another patient developing a hematoma managed conservatively (Clavien I). Four patients had no evidence of disease at a median follow up of 30 months (range 9-60 months). One patient developed metastatic disease 48 months following ablation. All patients had stable GFR after ablation, with none requiring a return to dialysis.

Conclusions

Our single institution case series presents the largest reported series of focal ablative therapies for SRMs in transplant allograft kidneys. Our experience shows, with intermediate term follow up that focal ablative therapies are a feasible renal-sparing intervention for management of SRMs in transplant allograft kidneys.

Funding

None