Introduction

Radical nephrectomy (RN) is the preferred treatment of small renal masses (SRM) in renal transplant candidates. Given the high risk of surgical complications in this cohort, active surveillance (AS) may be an option as many lesions are indolent. Since data on the use of AS in this setting is lacking, we surveyed transplant surgeons across the US on their institutional practice patterns for treatment of SRM.

Methods

A 21-question online survey designed to analyze practice patterns of SRM management in renal transplant recipient candidates was sent to active transplant centers in the US. The list of recipients to whom the survey was distributed was obtained with permission from the American Society of Transplant Surgeons. All respondents were de-identified and consented to participate.

Results

We received 62 responses from 53 US Transplant Centers. All 11 United Network of Organ Sharing (UNOS) regions were represented. 38.7% (n=24) indicated that their institution does not follow formal guidelines for treatment of SRM. The majority (85.5%, n=53) indicated that their institution screens for renal masses in candidates for renal transplantation. RN was the preferred treatment (59%, n=61), followed by AS (21.3%, n=13), partial nephrectomy (14.8%, n=9) and focal ablative therapy (4.9%, n=3). Additionally, 14.5% (n=9) respondents routinely perform renal mass biopsy before any decision is made._x000D_ _x000D_ Although the majority of centers prefer definitive treatment, 27% allow AS prior to transplantation. For those institutions that allow AS, 95.5% felt comfortable if mass was <1 cm, 41.7% if <2 cm and 20.8% if 2-4 cm. Among institutions that allow AS, none alter their immunosuppressive regimen. _x000D_ _x000D_ Amongst the responders whose institutions did not allow active surveillance, 77.4% indicated that if presented with long-term data showing safety of AS, they would perform immediate transplantation and monitor SRM in these patients. _x000D_

Conclusions

Variations in practice patterns suggest the need for standardized guidelines in the management of SRM in renal transplant candidates. Though RN is the preferred treatment, most transplant surgeons would consider AS if long term safety data were available.

Funding

None