Long-term results of dialysis and transplantation in patients with end-stage renal failure from hypernephroma.

We analyzed long-term, 2- to 9-year results and risk factors in 13 patients treated with dialysis and transplantation for hypernephroma. Eight were dialyzed only, 6 died, 4 of them from metastatic disease that occurred in less than 8 months in 3. Five patients were also transplanted. Three died, 1 of metastatic disease. Two are alive, 1 with metastatic disease, 6 years after transplant, 3 years after diagnosis of metastasis. There were no differences in age and sex in those with early metastatic disease when compared to those without, but stage III-IV disease and time of less than 5 years between first and second nephrectomy were more common in those with early metastatic disease. These data indicate that a 7-month waiting time on dialysis is enough to avoid transplanting those with early recurrence, and that patients with stage III-IV and early reappearance of tumor in the second kidney are best treated with conservative management rather than a second total nephrectomy.