Modi Neal, Dougherty Kristen, Nazzal Mustafa
Department of Surgery, Saint Louis University School of Medicine, St. Louis, USA.
Department of Surgery, Saint Louis University Hospital, St. Louis, USA.
Cureus. 2022 Dec 14;14(12):e32531. doi: 10.7759/cureus.32531. eCollection 2022 Dec.
Extrahepatic malignancies are a relatively rare incidental finding during liver transplant work-up that provides a significant barrier to continued transplant evaluation and requires treatment to limit the risk of recurrence. There have only been 11 previously reported cases of pre-liver transplant renal cell carcinoma (RCC), of which all underwent partial or radical nephrectomy. Percutaneous cryoablation therapy has been gaining acceptance as a curative treatment alternative for RCC and is a new therapeutic standard for patients who are poor candidates for surgical resection. Recent studies have demonstrated the safety and efficacy of cryoablation for RCC in native kidneys and in solid masses in kidney allografts, but there is no data on the efficacy or recurrence of RCC when cryoablation is used for the treatment of RCC in a native kidney prior to solid organ transplantation. The patient underwent percutaneous cryoablation therapy of a T1a RCC of the native kidney 10 months prior to orthotopic liver transplant (OLT) without subsequent partial or radical nephrectomy. At seven years post-ablation therapy, the patient has no evidence of tumor recurrence despite immunosuppressive therapy post-transplantation. Cryoablation is potentially a safe and highly effective means of treating RCC in patients who are not candidates for nephrectomy secondary to complications associated with end-stage liver disease. In our case, the patient was treated with cryoablation and received standard post-transplant immunosuppression without recurrence of RCC at seven years. More studies are needed to determine inclusion and exclusion criteria for cryoablation and to confirm long-term efficacy as well as a strategy for duration and frequency of surveillance in these patients.
肝外恶性肿瘤是肝移植术前评估中相对罕见的偶然发现，这对继续进行移植评估构成了重大障碍，需要进行治疗以降低复发风险。此前仅有11例肝移植术前肾细胞癌（RCC）的报道病例，所有病例均接受了部分或根治性肾切除术。经皮冷冻消融治疗已被广泛接受为RCC的一种根治性治疗选择，是手术切除不佳候选患者的新治疗标准。最近的研究表明，冷冻消融治疗对原位肾和肾移植实体肿块中的RCC具有安全性和有效性，但对于在实体器官移植前使用冷冻消融治疗原位肾RCC的疗效或复发情况尚无数据。该患者在原位肝移植（OLT）前10个月接受了经皮冷冻消融治疗，治疗的是原位肾的T1a期RCC，随后未进行部分或根治性肾切除术。在消融治疗后七年，尽管移植后进行了免疫抑制治疗，但患者没有肿瘤复发的迹象。对于因终末期肝病相关并发症而不适合进行肾切除术的患者，冷冻消融可能是一种安全且高效的治疗RCC的方法。在我们的病例中，患者接受了冷冻消融治疗，并接受了标准的移植后免疫抑制，七年未出现RCC复发。需要更多研究来确定冷冻消融的纳入和排除标准，并确认长期疗效以及这些患者的监测持续时间和频率策略。
