Status:
Ready to upload
Record number:
1993
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: No tumor seen at 14-68 month followup
Alerting signals, symptoms, evidence of occurrence:
None. This small series summarizes several tumor types that were not transmitted to recipients. In 4 cases, renal cell carcinoma was found after the livers had been implanted (kidneys were not used). Kidney tumors were 1.0-4.5 cm, all Stage 1. No tumors were transmitted with 14-55 month followup. One donor had prostate carcinoma, 0.5 cm Stage A1 (localized) found at autopsy. The liver recipient did not develop tumor at 62 month followup. One donor had prostate carcinoma (1.3 cm, Stage A1) and glioblastoma found at autopsy. The liver recipient had no tumor at 44 month followup. A right kidney recipient had transplantectomy on day 12, apparently for unrelated reasons, and has not developed tumor at 2 year followup.
Demonstration of imputability or root cause:
N/A
Imputability grade:
Not Assessable
Groups audience:
Keywords:
Suggest new keywords:
Single center series
Deceased donor
Risk of transmission
Liver transplant
Kidney transplant
Astrocytoma/glioblastoma multiforme (WHO grade 4)
Renal cell carcinoma
Prostate adenocarcinoma/carcinoma
Reference attachment:
Suggest references:
Serralta AS, Orbis FC, Sanjuan FR, Moya AH, López-Andújar R, Pareja EI, et al. If the donor had an early-stage genitourinary carcinoma and the liver has already been implanted, should we perform the transplantectomy? Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 2003;9(12):1281-5.
Note:
Clone of record 1886 (EP)
First review Mike 9/11/18.
Expert comments for publication:
The results of this series are consistent with current thinking that small prostate cancers have minimal to no risk for tumor transmission, and extrarenal organs from donors with small renal cancers also have an extremely low risk of tumor transmission. The kidneys in this series are discarded, although the current trend is to consider resection of small solitary tumors and use of otherwise acceptable kidneys for transplant.