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Record number:
1883
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:
24 years (first unspecific symptoms) / 26 years (diagnosis)
Alerting signals, symptoms, evidence of occurrence:
Gradual increase of recipient´s serum creatinine level for about 2 years from 1.1 to 1.5 mg/dl in combination with decline of the creatinine clearance rate from 109 to 54 ml/min. 2.2cm solid renal mass was detected, percutaneous biopsy showed grade 2 papillary RCC without evidence of metatstatic disease in sonography and MRI. Due to the recipient´s poor cardiac status, it was decided not to perform surgery (neither nephron-sparing tumor resection nor nephrectomy) but to perform percutaneous sonographically guided radio frequency ablation of the tumor. After two 10-minute ablations in one session, the immediately following contrast-enhanced CT scan showed no enhancement of the mass, consistent with successful ablation. Follow-up Imaging 6 and 14 months later revealed a size decrease of the mass to 1.7cm and no enhancement, indicating necrosis.
Demonstration of imputability or root cause:
Papillary RCC developed in kidney graft, no other tumor sites.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
Suggest new keywords:
malignancy
case report
kidney transplant
kidney and urinary tract
renal cell carcinoma
donor-derived
Reference attachment:
Suggest references:
Charboneau JW, O´Loughlin MT, Milliner DS, Engen DE. Sonographically guided percutaneous radio frequency ablation of a renal cell carcinoma in a transplanted kidney. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. 2002;21(11):1299-302.
Note:
First review done on 2018-09-09 (Kerstin)
Second review 9/11/18 Mike
Expert comments for publication:
This case does not describe a tumor transmission but a malignancy that developed in the transplanted kidney as de novo 2.2 cm tumor more than 20 years after transplantation. The special issue of this case report is the treatment with radio frequency ablation instead of surgery due to the poor cardiac condition of the recipient. 14 months after the successful procedure, there was no sign of tumor recurrence and the authors conclude that this might be a safe alternative and effective therapy for small, exophytic and superficially located RCC.