Case report: Renal Cell Carcinoma (RCC) after kidney transplant (2003)

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Record number: 
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: 
15 years
Alerting signals, symptoms, evidence of occurrence: 
At 15 years posttransplant: multiple masses found in transplant kidney following ultrasound for right upper quadrant abdominal pain -> nephrectomy-> malignancy (mate kidney normal). Multicentric papillary renal cell carcinoma (CA) at 29 locations of kidney (chromophil-basophilic CA (21), clear cell CA (5), chromophil-eosinophil CA (1), mixed CA (2). Assumption by authors that allograft was predisposed to malignant changes (donor-derived).
Demonstration of imputability or root cause: 
Donor-derived RCC arising in and limited to allograft kidney.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
kidney mass
kidney transplant
renal transplant
Suggest references: 
DeLong, M.J.; Schmitt, D.; Scott, K.M.; Ramakumar, S.; Lien, Y.H. Multicentric papillary renal carcinoma in renal allograft Am J Kidney Dis 2003; 42 (2) :381 - 4
need to specify exactly how tumors were detected (Done 7/7/15) ?symptoms or asymptomati/routine scan? add more keywords (Done 7/7/15)
Expert comments for publication: 
At 15 years post-transplant this would be considered to be a "donor derived" as opposed to "donor transmitted" tumor.