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Adverse Occurrence type:
(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: No transmissions were observed in 7 patients at 31-58 month followup
Alerting signals, symptoms, evidence of occurrence:
Demonstration of imputability or root cause:
Donors underwent nephrectomy for small (3.5 cm or less) renal cell carcinoma and had agreed to donate their kidneys for transplant.
Suggest new keywords:
Donor cancer without transmission
Single center series
Renal cell carcinoma
Wang X, Zhang X, Men T, Wang Y, Gao H, Meng Y, et al. Kidneys With Small Renal Cell Carcinoma Used in Transplantation After Ex Vivo Partial Nephrectomy. Transplant Proc. 2018;50(1):48-52.
second review Carl-Ludwig, agree to Michael
Expert comments for publication:
All tumors were clear cell renal cell carcinomas, 2.1-3.5 cm in diameter, grade 1-2. The authors note the short followup and observe that the patients need continued followup, they also suggest use of sirolimus-based immunosuppression in these patients. Their results are consistent with other recent reports of small renal tumors excised before transplant (follow-up time:2.5 to 4 years, half of the cases below 3.5 years).