Recurrence of Renal Cell Cancer After Renal Transplantation in a Multicenter French Cohort.

BACKGROUND: Renal cancer accounts for 3% of adult malignancies; renal cell carcinoma (RCC) represents 80% of all renal cancers, and is characterized by late recurrences. Recurrences after kidney transplantation are associated with a high mortality rate. We aimed to determine if recurrences are linked to tumor characteristics and to delays between diagnosis and transplantation. METHODS: We retrospectively analyzed data from French kidney-transplanted patients with medical histories of pretransplant renal cancer, focusing on the most common histological subtypes: clear cell and papillary cancers. Characteristics of the tumors, patients, and kidney transplantations were documented, and posttransplant patient survival was analyzed. RESULTS: Of 143 patients, 13 experienced cancer recurrence after kidney transplantation. The mean delay in recurrence was 3 ± 2.3 years posttransplantation, and the cumulative incidences of recurrence were 7.7% at 5 years and 14.9% at 10 years. The risk of recurrence was higher in patients with clear cell RCC (13% vs 0%, P = 0.015). There was no correlation between posttransplant recurrence and the interval before transplantation. Factors associated with a higher risk of cancer recurrence were histological clear cell RCC (P = 0.025), tumor stage pT2 (P = 0.002), and Fuhrman grade IV (P < 0.001). Recurrences were associated with a high mortality rate; 76.9% of patients with recurrences had died by the end of the follow-up period. CONCLUSIONS: Recurrences of clear cell RCC are not uncommon after kidney transplantation and are associated with very poor prognoses. These results should be considered before listing patients with a history of renal cancer for transplantation.

[Cutaneous infection due to Mycobacterium chelonae in a hemodialysed patient]. / Infection cutanée à Mycobacterium chelonae en hémodialyse.

We report a case of a hemodialysed patient who developed a cutaneous Mycobacterium chelonae infection. This infection was only localised on the left upper limb, downstream from the arteriovenous fistula. M. chelonae is an unusual human pathogen, which is present in soil, dust, and stagnant water. Various factors, especially immunosuppression can favour this sort of infection in humans. Because of the ubiquity of the mycobacterium, the source of the inoculation sometimes remains unknown. However, a great number of cases are related to nosocomial infections. The preferential localizations are cutaneous, ocular, and pulmonary. Some cases of cutaneous infections due to M. chelonae, or caused by other atypical mycobacterium, are described in renal transplantation, peritoneal dialysis and hemodialysis. In the case we describe here, the source of contamination was not identified. The outcome was favourable with clarithromycin. This treatment is still continued because of a reappearance of the lesions when treatment was discontinued.

[Transfer from chronic haemodialysis to peritoneal dialysis]. / Transfert en dialyse péritonéale après traitement par hémodialyse chronique.

Peritoneal dialysis patients are frequently transferred from peritoneal dialysis to haemodialysis. In contrary transfer from chronic haemodialysis to peritoneal dialysis is rare. The aim of this study is to describe the main characteristics and the outcome of the dialysis patients transferred from haemodialysis to peritoneal dialysis. We retrospectively analyzed the files of 25 patients treated by haemodialysis for more than 3 months between 1992 and 2002 and subsequently transferred on peritoneal dialysis. Technique survival was 56% at 1 year and 40% at two years in haemodialysis. Technique survival was lower in the group starting haemodialysis in emergency compared with the group of patients who did not need emergent haemodialysis (33 vs 77% at 1 year, P<0.05). The reasons for transfer from haemodialysis to peritoneal were vascular access problems (13/25), cardiovascular problems (7/25), and patient's choice (5/25). Automated peritoneal dialysis was used in 9 cases and continuous ambulatory peritoneal dialysis in 16 cases. In 13 cases peritoneal dialysis was performed by a home care nurse. At the initiation of peritoneal dialysis the mean age was 58+/-18 years, the mean Charlson's comorbidity score was 6.1+/-2.5 and 15 patients had a cardiovascular disease. The median time on peritoneal dialysis was 5.2 months. During the time on peritoneal dialysis sixteen patients presented at least one complication related to peritoneal dialysis. In addition fourteen patients were hospitalized for a reason which was not associated with peritoneal dialysis. Survival on peritoneal dialysis was 61% at six months and 35% at one year. In conclusion, in our study, patients transferred from haemodialysis to peritoneal dialysis have had a poor outcome on peritoneal dialysis. However, these patients presented numerous comorbid conditions at peritoneal dialysis initiation which could explain the poor outcome on peritoneal dialysis.