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Record number:
1537
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
(Council of Europe, 2022): To provide valid histological staging, complete tumour resection (R0) is required for acceptance of all organs; additionally, tumour-free margins are a prerequisite for transplant of the affected kidney. Paraffin section is superior to frozen section for the assessment of such biopsies. The contralateral kidney should always be examined for synchronous RCC (5 % of patients). RCC < 1 cm (stage T1a AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) can be considered minimal-risk for transmission; RCC 1-4 cm (stage T1a AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered low-risk; RCC > 4-7 cm (stage T1b AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered intermediate-risk; RCC > 7 cm (stage T2 AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered high-risk; RCC with extension beyond the kidney (stages T3/T4 AJCC 8th edn) is considered a contraindication to transplant; All RCC with WHO/ISUP grade III/IV (Fuhrman grade III/IV) are considered high-risk for transmission; Contralateral kidneys and other organs that are un¬involved in carcinoma are considered to represent minimal risk for transplantation when the RCC in the involved kidney is 4 cm or less and WHO/ISUP grade I-II. In all cases, follow-up surveillance is desirable.
RCC in the donor history: The transmission risk of treated RCC depends on the histological type of tumour [159] and its recurrence-free follow-up period. In general, in the first 5 years after initial diagnosis, risk categories correspond to those stated above (RCC diagnosed during donor procurement) if there is no suspicion of tumour recurrence in the donor. After this time, the risk of advanced stages may decrease.
Time to detection:
20 months
Alerting signals, symptoms, evidence of occurrence:
1 week after transplantation, small lesion in lower part of renal transplant probably misdiagnosed as dilated calyx. 20 months after the transplant, 3 cm lesion in lower part of the graft is detected. Recipient refuses any further diagnostics. 2 years later, lesion grown to 4.5x4.0x3.0cm, with histology performed consistent with renal cell carcinoma.
Demonstration of imputability or root cause:
Regarding the recipient of the contralateral kidney: a 6cm tumor was detected at 64 months from transplantation. The tumor (5-5.5cm) had already been present (but was undetected probably due to the same echogenity of tumor and renal parenchyma) at 46 months after transplantation, proven by retrospective analysis of ultrasound hard copies. Based on calculated tumor progression of 0.5cm/year, it was presumed that the tumor had been present in the kidney at the time of transplantation.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest references:
Heinz-Peer G et al. Renal cell carcinomas of donor origin in two kidney transplants from a single donor. Transplantation 1995 Mar 27; 59(6):912-3