Review article: Management of RCC and other renal masses in the kidney graft (2020)

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Most recent risk assessment for renal cell carcinoma (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 ed) 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 ed) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered low-risk; RCC > 4-7 cm (stage T1b AJCC 8th ed) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered intermediate-risk; RCC > 7 cm (stage T2 AJCC 8th ed) 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 ed) 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 un­involved 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 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.
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N/A: Review article discussing diagnosis and management of renal cell carcinoma in the transplant patient, both donor-transmitted and donor-derived types. Other tumors (e.g., angiomyolipoma, oncocytoma) are also briefly discussed.
Alerting signals, symptoms, evidence of occurrence: 
N/A: Various modes of presentation are discussed
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Suggest new keywords: 
Review article
Kidney transplant
Kidney recipient
Kidney transplantation
Angiomyolipoma (benign)
Renal cell carcinoma
Renal oncocytoma (benign)
Therapy discussed
Deceased donor
Living donor
Suggest references: 
Warren H, Olsburgh J. Management of Renal Cell Carcinoma and Other Renal Masses in the Kidney Graft. Curr Urol Rep. 2020;21(1):8.
First review MN 5/9/22 Second review 10/26
Expert comments for publication: 
This article reviews both the assessment of living and deceased donors for the possible presence of renal cell carcinoma (and other renal tumors) as well as diagnosis and modes of therapy employed in kidney transplant recipients who develop donor transmitted or donor-derived renal tumors. The bulk of the discussion regards renal cell carcinoma. However, points relevant for the management of angiomyolipoma and oncocytoma, in addition to various RCC subtypes such as papillary renal cell carcinoma, are discussed. A good overview of management and treatment strategies with discussion of surveillance, nephron sparing surgery and mTOR inhibitor use.