Registry Series (DTAC): Renal Cell Carcinoma Suspected at Time of Transplant

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Adverse Occurrence type: 
MPHO Type: 
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(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: 
Alerting signals, symptoms, evidence of occurrence: 
Not given
Demonstration of imputability or root cause: 
In this DTAC registry series of transplants from 179 donors, renal cell carcinoma was known or suspected at time of transplant in 147 and tumor was subsequently found after transplant (unsuspected at transplant) in 32. No transmissions were found in recipients when tumor was identified (and excised) prior to transplant (21 kidneys following tumor excision, 47 contralateral kidneys), 198 non-renal organs). In an additional 6 cases of live kidney donation with excision of tumor, no transmission was documented.
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Suggest new keywords: 
Registry series
Deceased donor
Living donor
Kidney transplant
Renal cell carcinoma
Donor cancer without transmission
Suggest references: 
Pavlakis M, Michaels MG, Tlusty S, Turgeon N, Vece G, Wolfe C, et al. Renal cell carcinoma suspected at time of organ donation 2008-2016: A report of the OPTN ad hoc Disease Transmission Advisory Committee Registry. Clin Transplant. 2019;33(7):e13597.
2nd review Carl-Ludwig: agree to Michael. Plese note: the study mentions 10 cases, where RCC was diagnosed with delay after transplant (one recipient identified with RCC), also mentioned occurence of de novo RCC after 2 years kidney TX (11), which is not considered as donor transmitted but donor derrived. This is based on the excellent discussion about the probable tumor growth, which in conclusion it makes unlikely to assume that the tumor was missed at organ procurement. I would not mention this in the record here, as it may confuse the reader without expert knowledge on this topic.
Expert comments for publication: 
This study supports the consideration of use of kidneys from donors with small, well differentiated solitary renal cell carcinomas following complete excision of tumor. Guidelines of the Council of Europe should be consulted, patients should be fully informed, and appropriate followup and plan for intervention if necessary should be instituted in such cases. Non-renal organs have also been successfully transplanted from these donors.