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Year : 2021  |  Volume : 15  |  Issue : 1  |  Page : 81-88

Immunosuppression after the diagnosis of renal allograft renal cell carcinoma in two transplant recipients: Case reports and review of the literature

1 Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
3 Department of Radiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
4 Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission30-Jun-2020
Date of Acceptance22-Nov-2020
Date of Web Publication31-Mar-2021

Correspondence Address:
Dr. Raja Ramachandran
Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijot.ijot_70_20

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Renal cell carcinoma (RCC) is a common solid malignancy among renal transplant recipients. While it commonly involves the native kidneys, renal allograft RCC is increasingly being reported in renal transplant recipients. Most often, renal allograft RCCs are locally confined and nephron-sparing interventions are successful treatments. Immunosuppression is typically reduced in transplant recipients who develop malignancies; however, there is no consensus on the same for transplant recipients with a diagnosis of RCC. We report two cases of renal allograft RCC who were successfully managed with ablative therapy and reduction of immunosuppression. However, both the patients developed irreversible graft dysfunction and are wait-listed in the deceased donor program for the second transplant. We highlight the deficiency of evidence and the need for further studies on the aspect of immunosuppression modification after the diagnosis of RCC in transplant recipients.

Keywords: Ablative therapy, allograft, immunosuppression, renal cell carcinoma, renal transplant

How to cite this article:
Bharati J, Gupta P, Gorsi U, Mavuduru RS, Kumar V, Rathi M, Kohli HS, Ramachandran R. Immunosuppression after the diagnosis of renal allograft renal cell carcinoma in two transplant recipients: Case reports and review of the literature. Indian J Transplant 2021;15:81-8

How to cite this URL:
Bharati J, Gupta P, Gorsi U, Mavuduru RS, Kumar V, Rathi M, Kohli HS, Ramachandran R. Immunosuppression after the diagnosis of renal allograft renal cell carcinoma in two transplant recipients: Case reports and review of the literature. Indian J Transplant [serial online] 2021 [cited 2021 Jul 30];15:81-8. Available from: https://www.ijtonline.in/text.asp?2021/15/1/81/312757

  Introduction Top

Kidney cancers, after lymphoproliferative disorders and epithelial neoplasms, are among the most frequent malignancies in renal transplant recipients.[1] While the site of renal cell carcinoma (RCC) postrenal transplant is most commonly the native kidneys, about 10% are in the renal allograft.[2] Most of the renal allograft RCCs are locally confined and amenable for nephron-sparing interventions. There is no consensus on the approach to immunosuppression modification after the diagnosis of RCC in a functioning allograft, which can have a large impact on the course of allograft survival. We report the successful management of two patients with nonmetastatic allograft RCC with ablative therapy and reduction of immunosuppression. However, both the patients developed irreversible allograft dysfunction and are on the waiting list of deceased donor programs for their second transplant. We have also reviewed the literature on immunosuppression modification after the diagnosis of RCC in a renal allograft.

  Case Reports Top

Case 1

A 22-year-old (male) renal transplant recipient presented in 2018 with occasional graft site pain for 2 months. He underwent renal transplantation in 2016 with his 52-year-old father as the donor. After basiliximab induction, maintenance immunosuppression was tacrolimus, mycophenolate mofetil (MMF), and prednisolone therapy. The initial posttransplant course was uneventful; however, his serum creatinine gradually increased to 1.5–2 mg/dl (12 months postsurgery). On examination, there was no allograft tenderness or mass palpated. Urine examination revealed no abnormalities and the serum creatinine was 3 mg/dl. Ultrasonography (USG) and Doppler imaging revealed a heterogeneous mass of 3.0 cm × 2.5 cm × 3.5 cm with increased vascularity in the upper pole of the renal allograft. Contrast-enhanced computed tomography (CECT) confirmed a heterogeneously enhancing round mass of 3.3 cm × 3.2 cm × 3 cm size involving the upper pole along with the pelvicalyceal system of the allograft kidney. There was no similar mass involving any abdominal organ. Fine-needle aspiration cytology (FNAC) revealed clusters of tumor cells admixed with eosinophilic material in a necrotic background suggestive of clear cell carcinoma [Figure 1]a, [Figure 1]b, [Figure 1]c. Fluorodeoxyglucose (FDG)-Positron emission tomography (PET) scan of the whole body did not reveal any metastasis. Radiofrequency ablation under ultrasound guidance was done considering the small size of the tumor (<5 cm), anticipated difficulties with nephron-sparing surgery, and avoidance of dialysis. Tacrolimus and MMF were discontinued after the diagnosis of RCC. However, his urine output declined steadily, and serum creatinine was 7 mg/dl after 3 months. USG of the renal allograft at 3 months showed shrunken kidney (4 cm × 5 cm) without any apparent hypo or hyperechoic lesion. He was started on maintenance hemodialysis and is currently listed in the deceased donor transplant program. At 2 years of follow-up, USG of renal allograft showed no mass or cyst.
Figure 1: (a-c) Fine needle aspiration smears from the renal mass showing loose clusters of tumor cells with moderate nuclear pleomorphism, large round nuclei, prominent nucleoli, and abundant amount of clear pale cytoplasm. Thin strands of eosinophilic basement membrane-like matrix material can also be noted in the clusters (May Grunwald Giemsa; a: ×10, b: ×20, c: ×40)

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Case 2

A 50-year-old (male) renal transplant recipient presented in January 2020 with fever and anorexia for 2 months. He underwent renal transplantation in 2006 with his 55-year-old aunt as the donor. He was on tacrolimus, MMF, and prednisolone therapy without any details on prior induction therapy. The initial posttransplant course was uneventful, and his serum creatinine was 1.5 mg/dl until 2016 when he underwent graft biopsy for increasing serum creatinine to 2.1 mg/dl. The histology revealed posttransplant immunoglobulin A nephropathy, and the serum creatinine slowly increased to 3 mg/dl 3 months before the current presentation. USG revealed a 2.5 cm × 2.5 cm × 3 cm heteroechoic mass along with increased vascularity in the upper pole of the transplanted kidney. CECT of the abdomen showed a similar mass with multiple conglomerated necrotic mesenteric lymph nodes. CE-USG of transplant kidney showed Bosniak type IV cyst suggestive of RCC and FDG-PET scan did not reveal any metastasis. FNAC from the mesenteric node showed necrotic granulomatous inflammation without any atypical cells, and Ziehl–Neelsen stain was strongly positive for acid-fast bacteria suggestive of tuberculous lymphadenopathy. His serum creatinine at presentation was 4 mg/dl with a urine output of 1.5 L/day. With a probable diagnosis of nonmetastatic RCC based on radiological features, cryoablation was performed owing to residual graft function and small size of the tumor. Reduction in immunosuppression (to only steroids) and initiation of antitubercular therapy resulted in fever defervescence. No immediate postprocedure complications were noted; however, after 2 weeks following intervention, he developed increasing serum creatinine and oliguria. On the initiation of maintenance hemodialysis, the patient awaits his second transplant.

Summary of studies describing immunosuppression after the diagnosis of renal cell carcinoma in renal allograft

We conducted an extensive literature search on postrenal transplant RCC managed with nephron-sparing intervention and modification of immunosuppressive therapy. We used the following search terms in English manuscripts: RCC and renal transplant, RCC in the renal allograft, kidney cancer, and renal allograft and renal mass in transplanted kidney in MEDLINE database using PubMed interface. After careful reading, pertinent references from the articles were selected for further search. Of 49 articles with desired characteristics, 27 were excluded on the following grounds: 9 articles as they included cases of RCC in renal allograft which were treated with graft nephrectomy and cessation of immunosuppression and 18 articles as they did not mention if modification of immunosuppression was done or not after the diagnosis of RCC. We included 23 articles: 3 single-center prospective observational studies,[3],[4],[5] (1) multi-center retrospective study,[6] (2) single-center retrospective studies,[7],[8] (4) case series,[9],[10],[11],[12] and 13 case reports[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25] which had information on modification (yes/no) of immunosuppression therapy and allograft outcomes after the intervention of RCC in the renal allograft. All, except four[15],[20],[22],[24] articles, were published after the year 2000. The details, as shown in [Table 1] and [Table 2], were noted from each article. A total of 110 patients from 23 articles were analyzed. The mean time to the diagnosis of RCC posttransplant ranged from 5.7 to 15.6 years, and the mean age of the transplanted kidney at the time of diagnosis ranged between 37 and 55 years [Table 1]. Among the studies in [Table 1], papillary type of RCC was the most common histology in five studies,[3],[4],[5],[6],[9] clear cell type histology was the most common in three studies,[7],[11],[12] and other types of histology constituted a minority. Donor age was available in 12 studies and ranged from 24 to 78 years. Out of the total 110 patients included in [Table 1] and [Table 2], 78 (70.9%) patients did not have any change in immunosuppression after the diagnosis of RCC. However, immunosuppression details before the diagnosis of RCC were available in 100 of these 110 patients. Of these 100 patients, 76% patients were on cyclosporine A (CsA)-based therapy, 18% were on tacrolimus-based therapy, 35% received azathioprine, and 36% received MMF. Among 32 (29.1%) patients with a change in immunosuppression after diagnosis of RCC, 18 and 1 were switched to mTOR inhibitors from calcineurin inhibitors (CNIs) and MMF, respectively, 3 were switched from CsA to low dose tacrolimus (trough level <5 ng/ml) regimen, azathioprine was discontinued in 6, and the details of others are shown in [Table 1] and [Table 2]. Major (56.3%) immunosuppression change in patients involved switching CNI to mTOR inhibitors, and the mean prediagnosis serum creatinine ranged from 113.2 to 152.7 micromol/L in these patients. Among 78 patients with no change in immunosuppression, graft survival was stable in all except one patient who returned to dialysis for an unrelated cause; one patient had local tumor recurrence; and another one patient had residual tumor after nephron-sparing intervention. Among 32 patients with immunosuppression modification, 29 (90.6%) had stable graft function and 2 had recurrence at 3 months and 5 years following National Service Scheme (NSS), respectively. All the three patients who experienced deteriorating graft functions after the intervention (i.e., NSS and immunosuppression change) had poor graft function pre intervention.[10],[12] Information on other side effects of mTOR inhibitors was not available. The mean follow-up duration ranged from 17.4 to 43 months among the studies included in [Table 1].
Table 1: Cases series and observational studies which described immunosuppressive therapy modifications in patients with renal allograft renal cell carcinoma

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Table 2: Cases reports which described immunosuppressive therapy modifications in patients with renal allograft renal cell carcinoma

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  Discussion Top

We report renal allograft RCC in two transplant recipients, diagnosed 2- and 14-year posttransplant, respectively, who were treated with ablative therapy and reduction of immunosuppression. Both the patients had underlying chronic allograft injury at the time of diagnosis. While none of them had residual tumor or recurrence of cancer, they returned to maintenance dialysis during follow-up. A review of the literature highlights the uncertainty about the management of immunosuppression in renal transplant recipients who develop curable RCC. The balance between anticancer and antirejection treatment should be maintained as far as possible in such cases as treatment of cancer may come with the cost of pushing patients back to dialysis. Of note, patient survival on dialysis was found to be lower than survival with several solid-organ cancers.[26]

Kidney transplant is associated with the highest risk for kidney cancer amongst all solid-organ transplant recipients.[27] Among various risk factors, old age and possible effect of immunosuppression are common to both RCC in allograft and RCC in native kidneys of renal transplant recipients. Besides the older age of the transplanted kidney (54 years), there were no other obvious risk factors for RCC in case 1. Time to diagnosis after transplant was shorter in case 1 compared to others [Table 1] which could be due to donor-derived RCC origin. Although the donor did not develop RCC (of the contralateral kidney) on follow-up, the possibility of donor-derived RCC cannot be excluded short of DNA analysis of the tumor cells for origin, which was not done in our case. The role of standard maintenance immunosuppression as a risk factor for posttransplant RCC is inconsistent in different studies;[28],[29],[30] however, immunosuppression still remains a tentative risk for any cancer in all transplant recipients. Further, the rapid rise in the use of immune checkpoint inhibitors for metastatic native kidney RCC is an indirect evidence of the immune system's role in preventing and treating RCC.[31] Nevertheless, most of the reports describe renal allograft RCC to be locally confined, which are treated with nephron-sparing intervention successfully.[32],[33] We hypothesize that a superfluous reduction in immunosuppressive therapy in patients with renal allograft RCC for fear of tumour recurrence may jeopardize the allograft survival. Prospective clinical studies looking at long-term outcomes might improve our understanding of the management of immunosuppression in patients with renal allograft RCC.

We found that papillary and clear cell carcinoma was the most common RCC among the patients in the reviewed articles and most (71%) were continued on the same immunosuppression after the diagnosis of RCC. Continuation of the same immunosuppression (CNI in 94%) after RCC diagnosis seems to be safe in terms of long-term graft and tumor outcomes. Switch from CNI to mTOR inhibitors was the next common approach in the reviewed articles. It was associated with stable graft survival in those with good graft function at baseline. Among renal transplant recipients with de novo cancer (the majority having kidney cancers) after transplant in Hong Kong, conversion to mTOR inhibitors along with CNI minimization showed a trend toward a lesser recurrence of cancers than nonconversion group (5.4% versus 11.9%, respectively); however, cancer-free survival was similar in both the groups.[34] The worry with mTOR inhibitors is the commonly associated side effects leading to discontinuation.[35] Everolimus, typically at higher doses (5–10 mg daily) than that used as antirejection therapy (0.75–1.5 mg twice a day), is an approved agent to treat metastatic RCC,[36] which would worsen the side effects. Moreover, graft survival is poor with the use of mTOR inhibitors as maintenance immunosuppressive therapy in patients with compromised allograft function.[36] Immunosuppression was reduced in both our patients after the diagnosis of RCC; however, both developed irreversible graft function despite successful tumor management. Both our patients had suboptimal graft function before RCC diagnosis, and therefore, mTOR inhibitors were not used. We assume that allograft rejection could have contributed to allograft dysfunction in them as there were no other apparent factors for the same and we could not perform allograft biopsy.

The major concerns for transplanting a patient with previous RCC are (1) cancer recurrence after transplant (presumably due to immunosuppression) and (2) cancer-specific mortality after transplant, which is higher than the general population and also in patients with previous cancers as compared to those without.[37],[38] Tumor-free waiting time (0–5 years) for transplant in patients with RCC is largely based on data from the Cincinnati transplant registry.[39] Recent studies have reported no association between longer waiting time and risk of RCC recurrence.[40],[41] It is increasingly believed that tumor-free waiting time for transplanting a patient with RCC should be based on a careful consideration of individual characteristics such as histology, stage, and size.[41],[42] Although most studies have addressed waiting time concern in patients with previous native kidney RCC, extrapolation of the same to renal allograft RCC seems the best choice. Our patients are listed in a deceased-donor program due to nonavailability of live donors with a plan to screen them for tumor recurrence immediately before transplantation.

  Conclusion Top

We found that immunosuppression modification after the diagnosis of allograft RCC in renal transplant recipients lacks consensus and that discontinuation of immunosuppression may hasten allograft loss despite successful tumor management.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Birkeland SA, Løkkegaard H, Storm HH. Cancer risk in patients on dialysis and after renal transplantation. Lancet 2000;355:1886-7.  Back to cited text no. 1
Penn I. Primary kidney tumors before and after renal transplantation. Transplantation 1995;59:480-5.  Back to cited text no. 2
Chambade D, Meria P, Tariel E, Vérine J, De Kerviler E, Peraldi MN, et al. Nephron sparing surgery is a feasible and efficient treatment of T1a renal cell carcinoma in kidney transplant: A prospective series from a single center. J Urol 2008;180:2106-9.  Back to cited text no. 3
Viart L, Surga N, Collon S, Jaureguy M, Elalouf V, Tillou X. The high rate of de novo graft carcinomas in renal transplant recipients. Am J Nephrol 2013;37:91-6.  Back to cited text no. 4
Ploussard G, Chambade D, Meria P, Gaudez F, Tariel E, Verine J, et al. Biopsy-confirmed de novo renal cell carcinoma (RCC) in renal grafts: A single-centre management experience in a 2396 recipient cohort. BJU Int 2012;109:195-9.  Back to cited text no. 5
Tillou X, Guleryuz K, Doerfler A, Bensadoun H, Chambade D, Codas R, et al. Nephron sparing surgery for De Novo kidney graft tumor: Results from a multicenter national study. Am J Transplant 2014;14:2120-5.  Back to cited text no. 6
Végső G, Toronyi É, Deák PÁ, Doros A, Langer RM. Detection and management of renal cell carcinoma in the renal allograft. Int Urol Nephrol 2013;45:93-8.  Back to cited text no. 7
Varotti G, Bertocchi M, Barabani C, Terulla A, Fontana I. Nephron-sparing surgery for malignancies in kidney allografts. Transpl Int 2015;28:1342-4.  Back to cited text no. 8
Barama A, St-Louis G, Nicolet V, Hadjeres R, Daloze P. Renal cell carcinoma in kidney allografts: A case series from a single center. Am J Transplant 2005;5:3015-8.  Back to cited text no. 9
Swords DC, Al-Geizawi SM, Farney AC, Rogers J, Burkart JM, Assimos DG, et al. Treatment options for renal cell carcinoma in renal allografts: A case series from a single institution. Clin Transplant 2013;27:E199-205.  Back to cited text no. 10
Su MZ, Campbell NA, Lau HM. Management of renal masses in transplant allografts at an Australian kidney-pancreas transplant unit. Transplantation 2014;97:654-9.  Back to cited text no. 11
Tuzuner A, Çakir F, Akyol C, Çelebi ZK, Ceylaner S, Ceylaner G, et al. Nephron-sparing surgery for renal cell carcinoma of the allograft after renal transplantation: Report of two cases. Transplant Proc 2013;45:958-60.  Back to cited text no. 12
Kaouk JH, Spana G, Hillyer SP, White MA, Haber GP, Goldfarb D. Robotic-assisted laparoscopic partial nephrectomy for a 7-cm mass in a renal allograft. Am J Transplant 2011;11:2242-6.  Back to cited text no. 13
Hoda MR, Hamza A, Wagner S, Greco F, Fornara P. Recurrence of renal cell carcinoma in a renal allograft after partial transplant nephrectomy: A case report. Urol Int 2009;83:239-41.  Back to cited text no. 14
Park KI, Inoue H, Kim CJ, Tomoyoshi T. Nephron sparing surgery for de novo renal cell carcinoma in an allograft kidney: A case report. Int J Urol 1997;4:611-4.  Back to cited text no. 15
Li JY, Yong TY, Rao M, Coates PT. Partial nephrectomy for renal cell carcinoma in an allograft kidney with limited functional reserve. NDT Plus 2009;2:312-3.  Back to cited text no. 16
Lamb GW, Baxter GM, Rodger RS, Aitchison M. Partial nephrectomy used to treat renal cell carcinoma arising in a live donor transplant kidney. Urol Res 2004;32:89-92.  Back to cited text no. 17
Ribal MJ, Rodriguez F, Musquera M, Segarra J, Guirado L, Villavicencio H, et al. Nephron-sparing surgery for renal tumor: A choice of treatment in an allograft kidney. Transplant Proc 2006;38:1359-62.  Back to cited text no. 18
Numakura K, Satoh S, Tsuchiya N, Saito M, Nara T, Huang M, et al. De novo renal cell carcinoma in an allograft kidney treated with nephron-sparing surgery: A case report. Prog Transplant 2014;24:328-31.  Back to cited text no. 19
Krishnamurthi V, Novick AC. Nephron-sparing surgery in a renal allograft. Urology 1997;50:132-4.  Back to cited text no. 20
Thomalla JV. Renal cell carcinoma in a renal allograft successful treatment with 5 year follow-up. Clin Med Res 2004;2:151-3.  Back to cited text no. 21
Höppner W, Grosse K, Dreikorn K. Renal cell carcinoma in a transplanted kidney: Successful organ-preserving procedure. Urol Int 1996;56:110-1.  Back to cited text no. 22
De Simone P, Antonacci V, Rosa F, Verzaro R. Nephron-sparing surgery for de novo renal cell carcinoma in a 19-year-old transplanted kidney. Transplantation 2004;77:478.  Back to cited text no. 23
Kunisch-Hoppe M, Hoppe M, Bohle RM, Rauber K, Weimar B, Friemann S, et al. Metastatic RCC arising in a transplant kidney. Eur Radiol 1998;8:1441-3.  Back to cited text no. 24
Vázquez Alonso F, Cardozo Rodríguez E, Puche Sanz I, Flores Martin JF, Molina Hernandez JM, Berrio Campos R, et al. Nephron-sparing surgery for adenocarcinoma in a renal allograft. Case Rep Urol 2012;2012:692986.  Back to cited text no. 25
Naylor KL, Kim SJ, McArthur E, Garg AX, McCallum MK, Knoll GA. Mortality in incident maintenance dialysis patients versus incident solid organ cancer patients: A population-based cohort. Am J Kidney Dis 2019;73:765-76.  Back to cited text no. 26
Hall EC, Pfeiffer RM, Segev DL, Engels EA. Cumulative incidence of cancer after solid organ transplantation. Cancer 2013;119:2300-8.  Back to cited text no. 27
Kleine-Döpke D, Oelke M, Schwarz A, Schwager Y, Lehner F, Klempnauer J, et al. Renal cell cancer after kidney transplantation. Langenbecks Arch Surg 2018;403:631-41.  Back to cited text no. 28
Karami S, Yanik EL, Moore LE, Pfeiffer RM, Copeland G, Gonsalves L, et al. Risk of renal cell carcinoma among kidney transplant recipients in the United States. Am J Transplant 2016;16:3479-89.  Back to cited text no. 29
Hurst FP, Jindal RM, Graham LJ, Falta EM, Elster EA, Stackhouse GB, et al. Incidence, predictors, costs, and outcome of renal cell carcinoma after kidney transplantation: USRDS experience. Transplantation 2010;90:898-904.  Back to cited text no. 30
Ghatalia P, Zibelman M, Geynisman DM, Plimack ER. Checkpoint Inhibitors for the Treatment of Renal Cell Carcinoma. Curr Treat Options Oncol 2017;18:7.  Back to cited text no. 31
Griffith JJ, Amin KA, Waingankar N, Lerner SM, Delaney V, Ames SA, et al. Solid renal masses in transplanted allograft kidneys: A closer look at the epidemiology and management. Am J Transplant 2017;17:2775-81.  Back to cited text no. 32
Favi E, Raison N, Ambrogi F, Delbue S, Clementi MC, Lamperti L, et al. Systematic review of ablative therapy for the treatment of renal allograft neoplasms. World J Clin Cases 2019;7:2487-504.  Back to cited text no. 33
Cheung CY, Man Ma MK, Chak WL, Chau KF, Tang SC. Conversion to mammalian target of rapamycin inhibitors in kidney transplant recipients with de novo cancers. Oncotarget 2017;8:44833-41.  Back to cited text no. 34
Schena FP, Pascoe MD, Alberu J, del Carmen Rial M, Oberbauer R, Brennan DC, et al. Conversion from calcineurin inhibitors to sirolimus maintenance therapy in renal allograft recipients: 24-month efficacy and safety results from the CONVERT trial. Transplantation 2009;87:233-42.  Back to cited text no. 35
Escudier B, Albiges L, Sonpavde G. Optimal management of metastatic renal cell carcinoma: Current status. Drugs 2013;73:427-38.  Back to cited text no. 36
Farrugia D, Mahboob S, Cheshire J, Begaj I, Khosla S, Ray D, et al. Malignancy-related mortality following kidney transplantation is common. Kidney Int 2014;85:1395-403.  Back to cited text no. 37
Wong G, Chapman JR, Craig JC. Death from cancer: A sobering truth for patients with kidney transplants. Kidney Int 2014;85:1262-4.  Back to cited text no. 38
Penn I. Evaluation of transplant candidates with pre-existing malignancies. Ann Transplant 1997;2:14-7.  Back to cited text no. 39
Nguyen KA, Syed JS, Luciano R, Shuch B, Vourganti S. Optimizing waiting duration for renal transplants in the setting of renal malignancy: Is 2 years too long to wait? Nephrol Dial Transplant 2017;32:1767-73.  Back to cited text no. 40
Chapman JR, Webster AC, Wong G. Cancer in the transplant recipient. Cold Spring Harb Perspect Med 2013;3:a015677.  Back to cited text no. 41
Frascà GM, Brigante F, Volpe A, Cosmai L, Gallieni M, Porta C. Kidney transplantation in patients with previous renal cancer: A critical appraisal of current evidence and guidelines. J Nephrol 2019;32:57-64.  Back to cited text no. 42


  [Figure 1]

  [Table 1], [Table 2]


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