Single center series: Renal cell carcinoma (Potential donor study)

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Record number: 
2067
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
This study found 17 of 181 kidneys from patients who underwent partial or radical nephrectomy for stage I RCC to have tumors less than 3 cm in diameter and thereby possibly suitable for transplantation. This was a survey study; no transplants were performed. (Council of Europe, 2018): To provide a valid assessment, complete tumour resection (R0) prior to transplantation is required for the acceptance of all organs; additionally, tumour-free margins are a prerequisite for transplant of the affected kidney. The contralateral kidney should always be examined for synchronous RCC. RCC < 1 cm (Stage T1a AJCC 8th ed.) and nucleolar grade I/II (Fuhrman grade I/II) can be considered minimal risk for transmission. RCC 1-4 cm (Stage T1a AJCC 8th ed.) and nucleolar grade I/II (Fuhrman grade I/II) are considered low risk. RCC > 4-7 cm (Stage T1b AJCC 8th ed.) and nucleolar grade I/II (Fuhrman grade I/II) are considered intermediate risk. RCC > 7 cm (Stage T2 AJCC 8th ed.) and nucleolar grade I/II (Fuhrman grade I/II) are considered high risk. RCC with extension beyond the kidney (Stages T3 or T4 AJCC 8th ed.) is considered a contraindication to transplant. All RCC with nucleolar grade III/IV (Fuhrman grade III/IV) are considered high risk for transmission. Contralateral kidneys and other organs that are uninvolved by carcinoma are considered to represent minimal risk for transplantation when the RCC in the involved kidney is 4 cm or less and Fuhrman or nucleolar grade I-II. Followup surveillance is recommended. In the case of a donor with a history of renal cell carcinoma, the transmission risk of treated RCC depends on the recurrence-free follow-up period. In general, in the Zirst 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
Living donor
Kidney transplant
Renal cell carcinoma
Suggest references: 
Arpali E, Gunaydin B, Turan T, Caskurlu T, Yildirim A, Kocak B. Kidneys with small renal masses: Can they be utilized for kidney transplantation in the era of partial nephrectomy? Turk J Urol. 2018;44(6):503-7.
Note: 
agree, second reviewe Carl-Ludwig
Expert comments for publication: 
The authors found approximately 10 of kidneys resected for stage I RCC to be possibly suitable for transplantation. This is a consideration, although others have argued against performing a total nephrectomy if a partial nephrectomy will suffice, given the possible long-term risk to the potential donor if a second carcinoma were to arise in the contralateral kidney. Most recent urology guidelines recommend nephron sparing partial nephrectomy in such small stage I RCC. Therefore, the number of cases may not increase.