Native Kidney Cancer in a Kidney Transplant Recipient

Question
What is your recommendation for a patient with native kidney cancer stage pT2 discovered 3 years after kidney transplantation? The graft is doing well, but I am afraid to continue with full immunosuppression.

Sergio Ximenes, MD
Expert Response from Velma Scantlebury, MD
Professor of Surgery; Chief, Division of Transplantation, Department of Transplant, University of South Alabama Medical Center, Mobile, Alabama

I will assume that this patient had a T2 lesion without nodes or metastases since it was not mentioned. Lesions that are low-grade, < 2 cm, and asymptomatic are less likely to become problematic. With nephrectomy being the treatment of choice, alterations in immunosuppression might be recommended because of the lower survival rates of chronically immunosuppressed patients compared with nonimmunocompromised patients. If the patient is on triple immunosuppression and has had little or no problems with rejection, then perhaps lowering or discontinuing the third agent should be considered. Follow-up of this patient with routine surveillance is important, as are evaluation of the remaining native kidney with ultrasound every 6 months and computed tomography scans yearly.