ABSTRACT
Introducción: Los receptores de trasplante renal (TR) tienen al menos cuatro veces más riesgo de desarrollar neoplasias renales que la población general. Dado que estos pacientes suelen albergar tumores bilaterales o multifocales, el tratamiento de las masas renales sigue siendo un tema controvertido. Objetivo Explorar el tratamiento actual de las masas renales en riñones nativos de pacientes con TR. Adquisición de la evidencia Se realizó una búsqueda bibliográfica en la base de datos Medline/PubMed y se incluyeron 34 estudios en la presente revisión. Síntesis de la evidencia La vigilancia activa es una opción terapéutica factible en pacientes frágiles con masas renales menores de 3 cm. Dado que la cirugía conservadora de nefronas no está justificada en el caso de masas en el riñón nativo, la nefrectomía radical es el tratamiento estándar para los tumores renales en riñones nativos de receptores de TR, con técnicas laparoscópicas asociadas a tasas de complicaciones perioperatorias significativamente menores en comparación con el abordaje abierto. La realización de nefrectomía bilateral de riñón nativo y TR en el mismo acto puede ser una opción terapéutica en pacientes con masa renal y enfermedad poliquística renal, particularmente ante la ausencia de diuresis residual. Los pacientes con enfermedad localizada y nefrectomía radical satisfactoria no requieren ajuste del tratamiento inmunosupresor. En los casos con metástasis, los agentes mTOR pueden garantizar una respuesta antitumoral eficaz, manteniendo a la vez el tratamiento inmunosupresor adecuado para proteger el injerto. Conclusiones El cáncer renal en riñones nativos postrasplante es un acontecimiento frecuente. La nefrectomía radical es el tratamiento de elección en masas renales localizadas. Aún no se ha implementado una estrategia de cribado estandarizada y ampliamente aprobada para las neoplasias malignas en las unidades renales nativas. (AU)
Introduction: Kidney transplant (KT) recipients have a four-times higher risk of renal malignancies compared to general population. As these patients frequently harbor bilateral or multifocal tumors, the management of renal masses is still under debate. Objective To explore the current management of the native kidney masses in KT patients.Acquisition of evidenceWe performed a literature search on MEDLINE/PubMed database. A number of 34 studies were included in the present review. Synthesis of evidence In frail patients with renal masses below 3 cm, active surveillance is a feasible alternative. Nephron-sparing surgery is not justified for masses in the native kidney. Radical nephrectomy is the standard treatment for post-transplant renal tumors of the native kidneys in KT recipients, with laparoscopic techniques leading to significantly less perioperative complication rates as compared to the open approach. Concurrent bilateral native nephrectomy at the time of transplantation can be considered in patients with renal mass and polycystic kidney disease, especially if no residual urinary output is present. Patients with localized disease and successful radical nephrectomy do not require immunosuppression adjustment. In metastatic cases, mTOR agents can ensure efficient antitumoral response, while maintaining proper immunosuppression in order to protect the graft. Conclusions Post-transplant renal cancer of the native kidneys is a frequent occurrence. Radical nephrectomy is most frequently performed for localized renal masses. A standardized and widely-approved screening strategy for malignancies of native renal units is yet to be implemented. (AU)
Subject(s)
Humans , Kidney Transplantation , Carcinoma, Renal Cell , Nephrectomy , Neoadjuvant TherapyABSTRACT
INTRODUCTION: Kidney transplant (KT) recipients have a four-times higher risk of renal malignancies compared to general population. As these patients frequently harbor bilateral or multifocal tumors, the management of renal masses is still under debate. OBJECTIVE: To explore the current management of the native kidney masses in KT patients. ACQUISITION OF EVIDENCE: We performed a literature search on MEDLINE/PubMed database. A number of 34 studies were included in the present review. SYNTHESIS OF EVIDENCE: In frail patients with renal masses below 3â¯cm, active surveillance is a feasible alternative. Nephron-sparing surgery is not justified for masses in the native kidney. Radical nephrectomy is the standard treatment for post-transplant renal tumors of the native kidneys in KT recipients, with laparoscopic techniques leading to significantly less perioperative complication rates as compared to the open approach. Concurrent bilateral native nephrectomy at the time of transplantation can be considered in patients with renal mass and polycystic kidney disease, especially if no residual urinary output is present. Patients with localized disease and successful radical nephrectomy do not require immunosuppression adjustment. In metastatic cases, mTOR agents can ensure efficient antitumoral response, while maintaining proper immunosuppression in order to protect the graft. CONCLUSIONS: Post-transplant renal cancer of the native kidneys is a frequent occurrence. Radical nephrectomy is most frequently performed for localized renal masses. A standardized and widely-approved screening strategy for malignancies of native renal units is yet to be implemented.
