Single center series: Renal cell carcinoma and liver transplant (2003)

Most recent risk assessment for renal cell carcinoma (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 ed) 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 ed) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered low-risk; RCC > 4-7 cm (stage T1b AJCC 8th ed) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered intermediate-risk; RCC > 7 cm (stage T2 AJCC 8th ed) 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 ed) 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 un­involved 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 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.***************** Most recent risk assessment for prostate cancer (Council of Europe, 2022): If Gleason score is available, e.g., prostate diagnostics have been initiated a few days before organ procurement, then small intra-prostatic, low-grade (Gleason score ≤ 6) tumours are considered minimal-risk; intra-prostatic tumours with Gleason score 7 are considered low-to-intermediate risk; and intra-prostatic (pT2c) tumours with Gleason score > 7 are considered high-risk. Histological examination of the entire prostate with a valid grading of the tumour is time-consuming and the results might not always be available before an organ is transplanted. Donors with extra-prostatic tumour extension should be unequivocally excluded from the donation process as an unacceptable risk. Prostate cancer in the donor history: The acceptable time intervals for complete remission of prostate cancer are strongly correlated with stage and Gleason grade of the tumour. Donors with a history of curatively treated prostate cancer ≤ pT2 (tumour confined to prostate) and Gleason 3 + 3, as well as donors with very small prostate cancers and Gleason 3 + 3 under ‘active surveillance’, can be accepted for organ donation as minimal transmission risk at any time after diagnosis with the prerequisite of a frequently performed and non-suspicious follow-up. Prostate cancer < pT2 (confined to the prostate) and Gleason grade < 7 after curative treatment and cancer-free period > 5 years is considered minimal-risk. Higher stages/grades and/or shorter cancer-free periods require an individual risk assessment. A history of extra-­prostatic tumour extension poses a high risk for transmission. In any case, current PSA values should be obtained to compare to former ones and to assess the actual situation.