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Mayer BFB, Schunn MC, Urla C, Weinpert L, Tsiflikas I, Ebinger M, Fideler F, Neunhoeffer F, Weitz M, Nadalin S, Warmann SW, Fuchs J. Renal Autotransplantation for Resection of Bilateral Nephroblastoma and High-Risk Neuroblastoma in Children. Cancers (Basel) 2025; 17:989. [PMID: 40149323 PMCID: PMC11941411 DOI: 10.3390/cancers17060989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Revised: 03/12/2025] [Accepted: 03/14/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND/OBJECTIVES In bilateral nephroblastoma and high-risk neuroblastoma in children with extensive tumor involvement of the renal vessels or pedicle, complete tumor resection with preservation of healthy renal tissue is not feasible with in situ nephron-sparing surgery or vascular replacement. The aim of this study was to present our experience with ante situ tumor resection and renal autotransplantation (RATX) in these children. METHODS A retrospective study of children with bilateral nephroblastoma and high-risk neuroblastoma who underwent tumor resection and RATX at an international referral center for pediatric surgical oncology between 2006 and 2024 was performed. RATX was performed by transection of renal vessels, ante situ mobilization, and perfusion of the kidney with Bretschneider's solution. Tumor resection was performed on a bloodless kidney under hypothermia. RESULTS Ante situ tumor resection and RATX were performed at a median age of 36 months (range 13-62) in 4 children with bilateral nephroblastoma and 4 children with high-risk neuroblastoma. Complete tumor resection was achieved in all patients. One patient with neuroblastoma died of sepsis after 14 days. The 7 surviving patients showed no evidence of disease and normal to slightly decreased glomerulofiltration rates at a median follow-up of 20 months (range 3-155). Limitations include the retrospective design, small sample size, and heterogeneity of the study population due to very rare indication. CONCLUSIONS Ante situ tumor resection and RATX is a feasible surgical approach for children with multifocal bilateral nephroblastoma or high-risk neuroblastoma who are ineligible for in situ nephron-sparing surgery or vascular reconstruction.
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Affiliation(s)
- Benjamin F. B. Mayer
- Department of Paediatric Surgery and Paediatric Urology, University Children’s Hospital Tübingen, Hoppe-Seyler Straße 3, 72076 Tübingen, Germany; (C.U.); (L.W.); (J.F.)
| | - Matthias C. Schunn
- Department of Paediatric Surgery, Charité University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (M.C.S.); (S.W.W.)
| | - Cristian Urla
- Department of Paediatric Surgery and Paediatric Urology, University Children’s Hospital Tübingen, Hoppe-Seyler Straße 3, 72076 Tübingen, Germany; (C.U.); (L.W.); (J.F.)
| | - Lea Weinpert
- Department of Paediatric Surgery and Paediatric Urology, University Children’s Hospital Tübingen, Hoppe-Seyler Straße 3, 72076 Tübingen, Germany; (C.U.); (L.W.); (J.F.)
| | - Ilias Tsiflikas
- Division of Paediatric Radiology, Department of Diagnostic Radiology, University Hospital Tübingen, Hoppe-Seyler Straße 3, 72076 Tübingen, Germany;
| | - Martin Ebinger
- Department of Paediatric Hematology, Oncology, Gastroenterology, Nephrology and Rheumatology, University Children’s Hospital Tübingen, Hoppe-Seyler Straße 1, 72076 Tübingen, Germany; (M.E.); (M.W.)
| | - Frank Fideler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Hoppe-Seyler Straße 3, 72076 Tübingen, Germany;
| | - Felix Neunhoeffer
- Department of Paediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children’s Hospital Tübingen, Hoppe-Seyler Straße 3, 72076 Tübingen, Germany;
| | - Marcus Weitz
- Department of Paediatric Hematology, Oncology, Gastroenterology, Nephrology and Rheumatology, University Children’s Hospital Tübingen, Hoppe-Seyler Straße 1, 72076 Tübingen, Germany; (M.E.); (M.W.)
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Hoppe-Seyler Straße 3, 72076 Tübingen, Germany;
| | - Steven W. Warmann
- Department of Paediatric Surgery, Charité University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (M.C.S.); (S.W.W.)
| | - Jörg Fuchs
- Department of Paediatric Surgery and Paediatric Urology, University Children’s Hospital Tübingen, Hoppe-Seyler Straße 3, 72076 Tübingen, Germany; (C.U.); (L.W.); (J.F.)
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Order KE, Rodig NM. Pediatric Kidney Transplantation: Cancer and Cancer Risk. Semin Nephrol 2024; 44:151501. [PMID: 38580568 PMCID: PMC11734768 DOI: 10.1016/j.semnephrol.2024.151501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
Children with end-stage kidney disease (ESKD) face a lifetime of complex medical care, alternating between maintenance chronic dialysis and kidney transplantation. Kidney transplantation has emerged as the optimal treatment of ESKD for children and provides important quality of life and survival advantages. Although transplantation is the preferred therapy, lifetime exposure to immunosuppression among children with ESKD is associated with increased morbidity, including an increased risk of cancer. Following pediatric kidney transplantation, cancer events occurring during childhood or young adulthood can be divided into two broad categories: post-transplant lymphoproliferative disorders and non-lymphoproliferative solid tumors. This review provides an overview of cancer incidence, types, outcomes, and preventive strategies in this population.
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Affiliation(s)
- Kaitlyn E Order
- Division of Nephrology, Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | - Nancy M Rodig
- Division of Nephrology, Department of Pediatrics, Boston Children's Hospital, Boston, MA.
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Akhaladze DG, Minnullin MM, Krivonosov AA, Kachanov DY, Grachev NS. [Autologous kidney transplantation in a high-risk patient with locally advanced retroperitoneal neuroblastoma]. Khirurgiia (Mosk) 2024:63-69. [PMID: 38477245 DOI: 10.17116/hirurgia202403163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Surgery of locally advanced neuroblastoma with risk factors is one of the most difficult in pediatric surgery. Incidence of nephrectomy during subtotal or complete tumor resection is higher due to common involvement of renal vessels. We present a patient with locally advanced retroperitoneal neuroblastoma who underwent heterotopic kidney autotransplantation.
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Affiliation(s)
- D G Akhaladze
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - M M Minnullin
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - A A Krivonosov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - D Yu Kachanov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - N S Grachev
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
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