MOTS CLES Nephrectomie ; Transplantation ; Donneur vivant ; Laparoscopie ; Assistance manuelle Resume But.— La nephrectomie laparoscopique en transplantation renale a partir de donneurs vivants est devenue progressivement la technique de choix du fait de sa faible morbidite pour le donneur. Notre but est de comparer ses resultats a ceux de la lombotomie en termes de complications chirurgicales et de fonction des transplants. Materiels et methodes.— Soixante nephrectomies effectuees par lombotomie ont ete retrospectivement comparees a 53 nephrectomies par laparoscopie manuellement assistee. Resultats.— Les deux groupes etaient comparables. Aucune conversion n’a ete necessaire dans le groupe laparoscopie. L’hospitalisation etait plus courte pour le groupe laparoscopie (moyenne 6,3 jours versus 7,8 jours) et la douleur postoperatoire a un mois moins frequente (7 % versus 31 %). La creatininemie moyenne des receveurs n’etait pas statistiquement differente a trois, six et 12mois : 112 (± 27) versus 122 (± 11), 111 (± 25) versus 119 (± 19), 114 (± 23) versus 122 (± 25). Il n’y avait aucune difference en termes de complications entre la laparoscopie manuellement assistee (deux fistules urinaires, trois hematomes de la loge du greffon dont une reprise pour saignement) et la lombotomie (une fistule, un hematome necessitant une reprise, deux stenoses necessitant une reimplantation pyelo-ureterale).
Objectives: The aim of this study was to assess the natural history of prostate cancer (PCa) in renal transplant recipients (RTRs) and to clarify the controversy over whether RTRs have a higher risk of PCa and poorer outcomes than non-RTRs, due to factors such as immunosuppression. Patients and Methods: We performed a retrospective multicenter study of RTRs diagnosed with cM0 PCa between 2001 and 2019. Primary outcomes were overall (OS) and cancer-specific survival (CSS). Secondary outcomes included biochemical recurrence and/or progression after active surveillance (AS) and evaluation of variables possibly influencing PCa aggressiveness and outcomes. Management modalities included surgery, radiation, cryotherapy, HIFU, AS, and watchful waiting. Results: We included 166 men from nine institutions. Median age and eGFR at diagnosis were 67 (IQR 60−73) and 45.9 mL/min (IQR 31.5−63.4). ASA score was >2 in 58.4% of cases. Median time from transplant to PCa diagnosis was 117 months (IQR 48−191.5), and median PSA at diagnosis was 6.5 ng/mL (IQR 5.02−10). The biopsy Gleason score was ≥8 in 12.8%; 11.6% and 6.1% patients had suspicion of ≥cT3 > cT2 and cN+ disease. The most frequent management method was radical prostatectomy (65.6%), followed by radiation therapy (16.9%) and AS (10.2%). At a median follow-up of 60.5 months (IQR 31−106) 22.9% of men (n = 38) died, with only n = 4 (2.4%) deaths due to PCa. Local and systemic progression rates were 4.2% and 3.0%. On univariable analysis, no major influence of immunosuppression type was noted, with the exception of a protective effect of antiproliferative agents (HR 0.39, 95% CI 0.16−0.97, p = 0.04) associated with a decreased risk of biochemical recurrence (BCR) or progression after AS. Conclusion: PCa diagnosed in RTRs is mainly of low to intermediate risk and organ-confined at diagnosis, with good cancer control and low PCa death at intermediate follow-up. RTRs have a non-negligible risk of death from causes other than PCa. Aggressive upfront management of the majority of RTRs with PCa may, therefore, be avoided.
