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Usefulness of an inline radiofrequency device in renal allograft preserving surgery.

Organ transplant recipients are known to have a higher incidence of neoplasms compared to cancer in the general population, although tumors occurring in allograft organs are relatively rare (1). Prolonged and intensive immunosuppression, chronicantigenicstimulation,andtheoncogenic effect of viruses are frequent mechanisms leading to malignant tumors (2). Renal cell carcinoma (RCC) is a consequence of either undetected presence in thedonororganordenovoposttransplantation development. Surgical management presents an oncological dilemma, as curative treatment usually requires allograft nephrectomy and permanent dialysis. However, nephron-sparing renal allograft surgery has been recently proposed as an alternative approach enabling complete tumor removal and graft function preservation (3–5). We report the first known case of partial nephrectomy on renal allograft tumor using an inline radiofrequency (ILRFC) device. A 38-year-old patient who had previously undergone two kidney transplantations (1980 and 1993) was referred to our urology department. On abdominal computed tomography scan, an 18-mm lower pole solid mass lesion of the graft was observed with no distant metastasis. Ultrasonography-guided biopsies confirmed clear cell carcinoma, Fuhrman’s low grade. Due to tumor size, localization, histological data, context of second transplantation, and immunosuppression, a partial nephrectomy was performed. Perioperative ultrasonography control of the in-depth tumoral infiltration was required. Kidney resection was performed using the ILRFC coagulation device because simple enucleation was not recommended (Fig. 1). This procedure was used only as a hemostatic aid. Based on hepatic surgery data and an experimental animal study reported by Haghighi et al., localization and positioning of electrodes in the ILRFC probes were deeply inserted through the kidney parenchyma along the intended resection line (6–8). Pelvocaliceal injury with urine leak may sometimes occur during partial nephrectomy using radiofrequency (9). In order to prevent such complication, the authors suggest ultrasonography control and surgical palpation prior to ILRFC electrode parenchyma insertion. Sequential three-minute coagulation cycles were delivered to coagulate the full length of the resection plane (approximately 3 cm wide 3 cm long 3 cm deep). The malignant nature of the lesion and tumoral negative margins were confirmed by perioperative histological examination. No transfusions were necessary and postoperative renal function remained uneventful. Follow-up computed tomography scan at three and six months showed normal renal allograft healing with no tumor recurrence. In conclusion, the authors would like to underline the following points regarding ILRFC procedure: