Status:
Ready to upload
Record number:
1880
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:
13 years after kidney transplantation, solitary cystic lesion detected at lower pole of kidney graft procured from a DBD donor (2.3cm). This was observed for 7 years, at size of 4.0 cm. resection was considered. No symptoms else, good graft function.
Alerting signals, symptoms, evidence of occurrence:
Solitary Cystic Lesion in kidney graft with increase of size. 20 years after TX, partial graft nephrectomy including the Tumor with the rest of the graft left in situ at well function and no Tumor recurrence. Diagnosis: papillar RCC Grad 1, Fuhrman's nuclear grade 2, and stage pT1a,N0,M0.
Donor origin was confirmed by microsatellite analysis with the intention to exclude recipient origin - which would require other therapeutic strategies. Concerning cystic lesions the authors mention that acquired or congenital cystic disease should be excluded too (as shown by no pathological signs regarding the contralateral graft, resected after 12 years from the same DBD donor).
Demonstration of imputability or root cause:
Microsatellite analysis on genomic DNA.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
Case Report
Deceased donor
Kidney transplant/Kidney recipient/Kidney transplantation
Microsatellite DNA fingerprinting
Renal cell carcinoma
Malignancy
BDB
Reference attachment:
Suggest references:
Naruke Y, Ito M, Mihara Y, Umezaki Y, Matsuya F, Hayashi M, et al. De novo papillary renal cell carcinoma in an allograft kidney: evidence of donor origin. Pathology international. 2011;61(11):694-6.
Note:
Second reviewer MC:
I have changed the estimated frequency (it said not reported) by the Risk assessment 2018 CoE- Renal cell carcinoma, that was included into the experts comments. Please review.
I would perhaps move this comment : "Of note, preserving the kidney graft by partial nephrectomy is an interesting approach which may require strict surveillance of the recipient as immunosuppression will have to be continued. But the concept seemed to be successful (the reviewer knows an unpublished case of a multilocular RCC where multiple Tumors had been resected too with the aim to avoid return to dialysis - or to prolong this interval)" currently included in alerting signals, etc, into the Expert comment publication. I'm afraid I haven't been able to find/extract that out of this review.
I understand it is a donor derived tumor, do we have to somehow specify that for searches purposes? Please confirm.
CL. I moved the text, I suggest to keep the comment internal about the unpublished case and to soften the statement as we lack enough data.
Expert comments for publication:
Of note, preserving the kidney graft by partial nephrectomy is an interesting approach which will require strict surveillance of the recipient as immunosuppression will have to be continued. More data are required for further conclusions.