Review article: Use of kidneys with small RCC for transplant (2016)

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Record number: 
2041
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
Groups audience: 
Suggest new keywords: 
Malignancy
Review article
Deceased donor
Living donor
Kidney transplant
Suggest references: 
Lugo-Baruqui A, Guerra G, Arocha A, Burke GW, Ciancio G. Use of Kidneys with Small Renal Tumors for Transplantation. Current Urology Reports. 2016;17(1):3-7.
Note: 
Carl-Ludwig: nice review, agree to Michael
Expert comments for publication: 
A review of several series, including the authors' own, showing the feasibility of using kidneys from donors with small renal tumors after resection. Also included are useful discussions of aspects of the surgical back table graft preparation of these kidneys, methods of posttransplant recipient monitoring, use of mTOR inhibitors, and ethical considerations for living donors with small renal tumors.