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Cancer in Kidney Transplant Patients – Occurrence Frequency & Treatment Options 

Kidney disease, Chronic kidney disease ckd, Doctor with human model to study and treat in hospital.

Many kidney transplant patients are overcoming the immediate threat of kidney disease only to face the challenge of a cancer diagnosis. This has many implications but for those who face kidney cancer in their transplanted kidney, it’s essential to find a suitable treatment.  For a kidney recipient who has only one kidney, cryoablation offers a minimally invasive procedure, that will obliterate the cancer while sparing the kidney. We explore the prevalence of cancer in kidney transplant patients in general and possible treatments for transplant patients with kidney cancer.  

 

The risk of cancer among kidney transplant recipients 

While kidney transplantation undoubtedly improves life expectancy and quality of life when compared to dialysis, they are left facing an increased risk of developing cancer. Kidney transplant recipients have an overall risk of cancer that is 3 times higher than the rest of the population. The most common cancer for these patients is skin cancer, specifically Kaposi’s sarcoma (Cancer that originates in the cells of the lymph or blood vessels), followed by hematological cancers. The risk of developing these cancers is 4 times higher during the first 2 years following the transplant. For renal transplant recipients, malignancy is the third most common cause of death. It is not surprising that the immunosuppressing medications necessary for the body’s acceptance of the transplant is also directly related to the increased risk of infection and cancer. 

The United Network for Organ Sharing (UNOS) registry lists that over 25,000 kidney transplants were performed in the United States, in 2022. These were obtained from deceased and living donors, which creates various health risks. The use of kidneys from living donors raises a question of whether the source of malignancy in kidney transplant recipients may also come directly from the donor. These, donor origin cancer (DOC), may be donor transmitted cancer (DTC) or donor derived cancer (DDC). DTC is cancer transmitted at the time of transplantation and DDC comes from or is derived from the donor tissue.   

 

Are diseased donors increasing the risk of cancer in kidney recipients?  

It appears that receiving a donor kidney from a diseased donor might leave recipients at a higher risk for developing post-transplant cancer. Two studies based on a registry analysis of Australian kidney transplant recipients found increased kidney cancer risk. The first reported that compared to kidney transplant recipients from a living donor, recipients of deceased donor kidneys have a 50% increase in cancer risk, particularly for cancers of the kidney and urinary tract.3 In the second registry analysis of Australian kidney transplant recipients, a high (7.8-fold) cancer death risk was observed for kidney cancer.4   

In a study by Ma MK et al (2020), the researchers raised the issue of the increasing trend of deceased organ donors. This phenomenon translates into a rise in the age of kidney donors, with 36% of the donors over 60 years old and 14% of the donors over 70 years old. With the increased age comes an increase in risk of cancer and increased risk for the transplant recipients.      

Living donors go through a rigorous process to ensure the health of the organ and the donor. On the other hand, when the organ comes from a deceased donor, that process is not possible, so the health of the donated organ is not certain 

 

Study points to cryoablation as a solution for the rise in kidney cancer among transplant patients –  

As we have seen, kidney transplant recipients are in general at higher risk for cancer. However, in a rare number of cases, people who have had kidney transplants get cancer in their kidney. This places them in dire need of an alternative to surgical treatments that might jeopardize the transplanted kidney. Cryoablation may be a suitable procedure in these cases, just as it may be the best form of intervention for other transplant patients who’ve been diagnosed with cancer. Due to their transplants, these patients are especially high risk, so a treatment that is minimally invasive would serve to minimize the risk, as opposed to a more invasive surgical intervention. 

Silvestri, T. et. al., described a case in their article of a kidney transplant recipient who was later diagnosed with renal cell carcinoma and was then treated by CT- guided percutaneous cryoablation. These researchers state that small tumor in a transplanted kidney represents an ideal case for percutaneous cryoablation and that the procedure seems to be safe. They also point out that avoiding open surgery in an immunocompromised patient is a distinct advantage for percutaneous cryoablation. 

In a study performed by members of the Renal Transplantation Committee of the French Urological Association (CTAFU), published in 2016, Guleryuz K. et al state that as kidney transplant recipients are getting older, we will see an increase in the numbers of de novo kidney tumors in transplant recipients. This same article refers to their national guidelines for Thermal Ablations. Accordingly, ‘RFA and cryoablation are viable therapeutic alternatives for the treatment of small renal masses in patients with a single kidney. These treatments have low morbidity and complication rates, and shorter hospital stays.   

I have seen great success in cryoablation of the kidney for a variety of patients, especailly those who are poorly suited for standard of care treatments. Indeed, in recent years, cryoablation for kidney cancer is being adopted as a promising minimally invasive treatment option for early-stage Renal cell carcinoma (RCC). Large studies show comparable oncological outcomes to surgery, with fewer complications and a shorter hospital stay.   

In an interesting study published in October 2023, researchers set out to explore the efficacy of cryoablation using a single probe and liquid nitrogen on the recurrence rate of renal tumors. Their findings indicate that single-probe cryoablation shows promise as a modality for treating small renal masses, offering advantages in terms of cost-effectiveness and ergonomics compared to traditional multi-needle argon-based cryotherapy. Most notably, the researchers of this study suggest that the insights from this study can be used to guide medical professionals in selecting efficient, cost-effective, and patient-friendly treatment options, contributing to the optimization of kidney tumor management and benefiting society as a whole. 

These findings are in line with several other studies. One independent study found a significant advantage in the ability to re-treat tumors that are initially resistant, achieving a subsequent local control rate of 100% in patients with kidney cancer tumors. 

 

Advantages of cryoablation patients with comorbidities 

Cryoablation brings many advantages to the treatment of kidney cancer, especially for kidney transplant patients or donors. When it comes to treating resectable kidney diseases, partial nephrectomy, often referred to as sparing-nephrectomy, stands out as the “gold standard.” It is recognized for its effectiveness in managing such conditions. Interestingly, cryoablation has shown comparable efficacy outcomes to partial nephrectomy. This suggests that cryoablation could be a viable alternative, providing similar effectiveness in treating resectable kidney diseases. Additionally, cryoablation is a minimally invasive and fast procedure requiring a shorter stay in the hospital versus nephron-sparing surgery.      

Patients have minimal scarring and procedures are fairly painless with only a mild sedation required because of the analgesic effect of the freezing temperature. Cryoablation is also safe and repeatable enabling further treatment and potentially reducing the impact of higher local recurrence after a single ablation. According to several guidelines (e.g.,NCCN; AUA, ESMO, EAU and ACTA), cryoablation is a viable treatment option for patients with multiple comorbidities or those deemed unfit for surgery. Cryoablation is considered a safe and effective treatment option for small kidney lesions.   

 

Studies demonstrate the efficacy of cryoablation in kidney cancer 

The interim results from the ICE-SECRET clinical trial add another layer of credibility to cryoablation’s effectiveness. With a significant portion of participants (89.5%) experiencing no recurrence or adverse effects (100%) a year post-treatment, the trial highlights the feasibility, safety, and oncologic comparability of cryoablation to Nephron Sparing Surgery (NSS) for managing small renal masses. 

The ICE-SECRET trail is being conducted using the ProSense™ system. ProSense™ employs liquid nitrogen (LN2) to create ultra-cold temperatures and a rapid freeze. The ProSense™ system by IceCure offers a transformative approach to kidney cryoablation, empowering physicians to provide a fast, minimally invasive treatment option. This system utilizes ultra-cold liquid nitrogen to effectively destroy tumors by freezing, providing a safe and efficient alternative to traditional surgical methods. Its ease of use and the promise of quick recovery make it an attractive choice for both healthcare providers and patients, potentially changing the landscape of kidney cancer treatment.  

The alignment of these findings with the National Comprehensive Cancer Network (NCCN) guidelines reinforces the notion that cryoablation is well-suited for certain patient groups. These include individuals not eligible for surgery, those who have undergone partial nephrectomy, or those with a single or transplanted kidney. Given these considerations, cryoablation represents a significant step forward in renal cancer treatment, offering a blend of efficacy, safety, and patient convenience that is increasingly important in today’s healthcare landscape. 

 

Conclusion 

In conclusion, as we navigate through the complexities of kidney transplantation and renal cancer treatment, it is imperative to continuously explore and embrace innovative solutions like cryoablation. Its potential to offer effective, patient-friendly, and cost-efficient treatment options not only enhances the quality of life for those affected but also contributes to the broader efforts in optimizing kidney tumor management. As research and clinical trials further validate the benefits of cryoablation, it holds the promise of becoming an integral part of renal cancer treatment paradigms, benefiting patients and healthcare systems alike.