Objective   To analyze the clinical characteristics, diagnosis, and treatment of renal cell carcinoma in kidney transplant recipients.

  Methods   The clinical data of 27 kidney transplant recipients (2 female and 25 male patients) with renal cell carcinoma admitted to Tianjin First Center Hospital between March 2011 and March 2023 were retrospectively analyzed. Twenty-four of the 27 patients underwent radical nephrectomy, including one who underwent bilateral surgery and one who underwent nephroureterectomy. Three patients were conservatively treated. The surgical approaches included open, laparoscopic, and robot-assisted laparoscopic procedures, and analyses were performed on the diagnosis and treatment process, pathological features, and surgical prognoses of patients.

  Results   The surgical duration was 148 min (range, 100–210 min), and the postoperative hospital stay was 7 d (range, 4–10 d). Twenty-four cases of renal cell carcinoma were detected in native kidneys, with an average diameter of (4.03±2.49) cm, including 6 cases of papillary renal cell carcinomas, 1 case of chromophobe cell carcinoma, and 17 cases of clear cell carcinomas. One of the conservatively treated patients with graft clear renal cell carcinoma was pathologically confirmed via biopsy puncture. The clinical stages of the 27 patients were divided based on the extent of the tumor (T), extent of spread to the lymph nodes (N), and presence of metastasis (M), referred to as the TNM staging criteria as follows: T1aN0M0 in 18 cases, T1bN0M0 in 4 cases, T2aN0M0 in 2 cases, and T4N1M1 in 3 cases. The average age at the first tumor diagnosis after transplantation was (51.21 ± 7.60) years. Median dialysis time before transplantation was 19 months (range, 1.2–72 months). The median time from tumor diagnosis to transplantation surgery was 95 months (range, 12–180 months). The median follow-up time of the 27 patients was 47 months (range, 3–147 months), and two patients died after 129 and 95 months of follow-up because of pneumonia and sepsis, respectively.

  Conclusions   Early diagnosis of renal cancer after renal transplantation is difficult because of multiple cystic changes and necrotic tendencies. In addition, it is especially important to have a standardized follow-up plan and determine the timing of prophylactic surgery.