TY - JOUR
T1 - Trends in management of the small renal mass in renal transplant recipient candidates
T2 - A multi-institutional survey analysis
AU - Beksac, Alp Tuna
AU - Paulucci, David J.
AU - Sfakianos, John P.
AU - Reddy, Balaji N.
AU - Gin, Greg E.
AU - Lerner, Susan M.
AU - Badani, Ketan K.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/8
Y1 - 2017/8
N2 - Introduction Patients with end-stage renal disease are under increased risk for renal cell carcinoma development, and radical nephrectomy is the preferred treatment in this setting. Owing to the increased surgical morbidity and mortality, active surveillance (AS) may be a valid option for treatment of small renal masses (SRM). As there is a lack of high-level evidence for treatment recommendations, we performed a survey analysis to analyze the treatment patterns of transplant surgeons. Material and methods A 21-question online survey designed to analyze the practice patterns to treat SRM in renal transplant recipient candidates was sent to active transplant centers in the United States. The list of recipients to whom the survey was distributed was obtained with permission from the American Society of Transplant Surgeons. Results We received 62 responses. All regions of United Network of Organ Sharing were represented. Radical nephrectomy 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). Among the responders whose institutions did not allow AS, 77.4% indicated that if presented with long-term data showing safety of AS, they would perform immediate transplantation and monitor SRM. Responders were more likely to allow immediate transplantation after radical nephrectomy (77.4%), as opposed to partial nephrectomy (58.1%) and focal ablation (45.2%). Conclusion Though radical nephrectomy is the preferred treatment, most transplant surgeons would consider AS if long-term safety data were available.
AB - Introduction Patients with end-stage renal disease are under increased risk for renal cell carcinoma development, and radical nephrectomy is the preferred treatment in this setting. Owing to the increased surgical morbidity and mortality, active surveillance (AS) may be a valid option for treatment of small renal masses (SRM). As there is a lack of high-level evidence for treatment recommendations, we performed a survey analysis to analyze the treatment patterns of transplant surgeons. Material and methods A 21-question online survey designed to analyze the practice patterns to treat SRM in renal transplant recipient candidates was sent to active transplant centers in the United States. The list of recipients to whom the survey was distributed was obtained with permission from the American Society of Transplant Surgeons. Results We received 62 responses. All regions of United Network of Organ Sharing were represented. Radical nephrectomy 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). Among the responders whose institutions did not allow AS, 77.4% indicated that if presented with long-term data showing safety of AS, they would perform immediate transplantation and monitor SRM. Responders were more likely to allow immediate transplantation after radical nephrectomy (77.4%), as opposed to partial nephrectomy (58.1%) and focal ablation (45.2%). Conclusion Though radical nephrectomy is the preferred treatment, most transplant surgeons would consider AS if long-term safety data were available.
UR - http://www.scopus.com/inward/record.url?scp=85017136405&partnerID=8YFLogxK
U2 - 10.1016/j.urolonc.2017.03.012
DO - 10.1016/j.urolonc.2017.03.012
M3 - Article
C2 - 28391999
AN - SCOPUS:85017136405
SN - 1078-1439
VL - 35
SP - 529.e17-529.e22
JO - Urologic Oncology: Seminars and Original Investigations
JF - Urologic Oncology: Seminars and Original Investigations
IS - 8
ER -