Subject review: Transplantation of kidneys with tumors (2016)

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(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: 
Alerting signals, symptoms, evidence of occurrence: 
Demonstration of imputability or root cause: 
N/a (subject review)
Imputability grade: 
Not Assessable
Groups audience: 
Suggest new keywords: 
Review article
Deceased donor
Renal cell carcinoma
Living donor
Kidney transplant
Suggest references: 
Frasca GM, D'Errico A, Malvi D, Porta C, Cosmai L, Santoni M, et al. Transplantation of kidneys with tumors. J Nephrol. 2016;29(2):163-8.
Expert comments for publication: 
Subject review as of 2016 regarding the utility of donor kidneys with small RCC for use in transplantation. The authors discuss various committee assessments (KDIGO 2009 do not discuss, European Best Practice Guidelines 2014 discourage, European Association of Urology 2015 suggest small RCC in donor may be suitable, DTAC 2011 provide guidelines and propose risk stratification) and also discuss other topics, such as possible conflict of interest when nephrectomy for small RCC is carried out in transplant centers, small possibility of aggressive behavior or multifocality of small tumors. Their conclusion is that this is a viable alternative in selected cases and the risk: benefit ratio needs to be assessed on an individual basis. Good background reading for this topic.