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Balzano E, Bernardi L, Candita G, Trizzino A, Petagna L, Bozzi E, Scalise P, Cristaudi A, Tincani G, Pezzati D, Ghinolfi D, Crocetti L. Transabdominal Robotic-Assisted Partial Nephrectomy and CT-Guided Percutaneous Cryoablation for the Treatment of De Novo Kidney Tumors After Liver Transplantation. Life (Basel) 2025; 15:254. [PMID: 40003663 PMCID: PMC11856640 DOI: 10.3390/life15020254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Revised: 01/29/2025] [Accepted: 02/04/2025] [Indexed: 02/27/2025] Open
Abstract
The management of de novo kidney tumors (DKTs) after liver transplantation (LT) is challenging due to previous transplant surgery and calcineurin inhibitors (CNI)-related nephrotoxicity. Minimally invasive renal-sparing strategies like robot-assisted partial nephrectomy (RPN) are favored, but a transperitoneal approach may be limited by the previous transplant surgery and the location of the DKT; in such cases, CT-guided cryoablation may be an alternative option. In this retrospective cohort study, we aimed to compare RPN and cryoablation for the treatment of DKT in LT recipients. The primary endpoints were the efficacy (R0 resection in RPN, absence of the tumor at first follow-up for cryoablation) and the safety of the procedures (postoperative morbidity and increase in creatine level). The periprocedural costs and the oncologic efficacy (recurrence and overall survival) were the secondary endpoints. Twelve LT recipients (91.7% males, mean age 65 years) underwent RPN (n = 6) or cryoablation (n = 6) for DKT; the median interval between LT and diagnosis of DKT was 142.5 vs. 117.5 months, respectively. Efficacy was obtained in all patients after RPN and cryoablation. Postoperative morbidity was 16.7% in each group, and the postoperative increase in creatinine values was similar. Hospital stay was shorter following cryoablation vs. RPN (3.1 vs. 6.7 days; p = 0.03). The mean procedural costs were higher for RPN. There was no mortality and none of the patients had signs of recurrence after a median follow-up of 40.5 months. Both RPN and CT-guided cryoablation were safe and effective for the treatment of selected patients with DKT after LT. When applicable, cryoablation may be cost-effective and provide faster recovery.
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Affiliation(s)
- Emanuele Balzano
- Hepatobiliary Surgery and Liver Transplant Division, Azienda Ospedaliero Universitaria Pisana (AOUP), University of Pisa, 56126 Pisa, Italy; (A.T.); (L.P.); (D.G.)
| | - Lorenzo Bernardi
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.B.)
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Gianvito Candita
- Interventional Radiology Division, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy (E.B.); (P.S.); (L.C.)
| | - Arianna Trizzino
- Hepatobiliary Surgery and Liver Transplant Division, Azienda Ospedaliero Universitaria Pisana (AOUP), University of Pisa, 56126 Pisa, Italy; (A.T.); (L.P.); (D.G.)
| | - Lorenzo Petagna
- Hepatobiliary Surgery and Liver Transplant Division, Azienda Ospedaliero Universitaria Pisana (AOUP), University of Pisa, 56126 Pisa, Italy; (A.T.); (L.P.); (D.G.)
| | - Elena Bozzi
- Interventional Radiology Division, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy (E.B.); (P.S.); (L.C.)
| | - Paola Scalise
- Interventional Radiology Division, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy (E.B.); (P.S.); (L.C.)
| | - Alessandra Cristaudi
- Department of Surgery, Lugano Regional Hospital, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (L.B.)
| | - Giovanni Tincani
- Hepatobiliary Surgery and Liver Transplant Division, Azienda Ospedaliero Universitaria Pisana (AOUP), University of Pisa, 56126 Pisa, Italy; (A.T.); (L.P.); (D.G.)
| | - Daniele Pezzati
- Hepatobiliary Surgery and Liver Transplant Division, Azienda Ospedaliero Universitaria Pisana (AOUP), University of Pisa, 56126 Pisa, Italy; (A.T.); (L.P.); (D.G.)
| | - Davide Ghinolfi
- Hepatobiliary Surgery and Liver Transplant Division, Azienda Ospedaliero Universitaria Pisana (AOUP), University of Pisa, 56126 Pisa, Italy; (A.T.); (L.P.); (D.G.)
| | - Laura Crocetti
- Interventional Radiology Division, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy (E.B.); (P.S.); (L.C.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
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Reyes A, Mohanty A, Pharaon R, Massarelli E. Association between Immunosuppressive Therapy Utilized in the Treatment of Autoimmune Disease or Transplant and Cancer Progression. Biomedicines 2022; 11:biomedicines11010099. [PMID: 36672607 PMCID: PMC9856025 DOI: 10.3390/biomedicines11010099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023] Open
Abstract
Autoimmunity and cancer rates have both been on the rise in Western civilization prompting many to investigate the link between the two entities. This review will investigate the complex interactions between the activation and deactivation of the immune system and the development of malignancy. Additional focus will be placed on the main classes of immune inhibitor therapy utilized in transplant patients and in autoimmune disease including TNF-alpha, Calcineurin, mTOR, purine synthesis antagonists and IMPDH inhibitors.
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