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Kidney Transplantation in Patients With Renal Cell Carcinoma: Defining When and Why

By: Joseph Cupolo
Posted: Monday, November 26, 2018

Many people with previous renal cell carcinoma may eventually require renal replacement therapy including kidney transplantation. However, Giovanni M. Frascà, MD, of Ospedali Riuniti, Ancona, Italy, and his colleagues warned that current guidelines and approaches as to which patients should receive kidney transplantation may be outdated and impractical. Of the several scoring systems used in clinical practice, one that allows stratification of patients according to their risk of metastases appears to be reliable, they added, in their review published in the Journal of Nephrology.

The researchers indicated that a fixed waiting time before a patient with a previous renal cancer is listed for renal transplantation is no longer justified, since it may lead to an unnecessary and harmful delay in receiving a graft. At present, there is enough evidence that some patients may be listed immediately, whereas others are at too high a risk of metastasis to benefit from a transplanted kidney or to improve their life expectancy due to the prolonged immunosuppressive therapy required.

At present, they added, no study has compared the different integrated prognostic systems available to identify which patients should or should not be transplant recipients. However, even though no specific study has been performed in immunosuppressed patients, these tools may help in selecting potential kidney transplant recipients. Patients with a high probability of being disease- or metastasis-free at a given point may safely receive a kidney graft, whereas those at high risk of relapsing or dying from the tumor are not candidates for transplantation, given the probability of a short survival. According to the authors, the main limitation of these tools is that they have not been validated in those receiving long-term immunosuppressive drugs, as in the case of transplanted patients.



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