Subject review: Renal cell carcinoma- use of kidneys with small tumors (2011)

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Record number: 
1918
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: 
N/A
Alerting signals, symptoms, evidence of occurrence: 
N/A
Demonstration of imputability or root cause: 
N/A
Imputability grade: 
Not Assessable
Groups audience: 
Suggest new keywords: 
Review article
Deceased donor
Living donor
Kidney transplant
Renal cell carcinoma
Suggest references: 
Nicol D, Fujita S. Kidneys from patients with small renal tumours used for transplantation: outcomes and results. Current opinion in urology. 2011;21(5):380-5.
Note: 
Reviewed 7/26/19; OK to upload. MN
Expert comments for publication: 
Subject review (2011) regarding use of kidneys with small renal tumors for transplantation. Authors point out the then current status of partial versus radical nephrectomy for small renal cancers and recommend that, for those patients opting for radical nephrectomy, the possibility of offering the kidney for transplant be discussed (after the decision for radical nephrectomy is made). They also recommend consideration of use of deceased donor kidneys with T1 tumors for transplantation following excision of the tumor and recommend that in the case of live donation, kidneys not be rejected if there is a small tumor that can be excised. A literature review highlighting the low risk of recurrent or metastatic disease, and the posttransplant treatment options available in the case of tumor emergence, is presented.