Case Report: Cryoablation of Renal Cell Carcinoma in Renal Allograft (2019)

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(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: 
5 years
Alerting signals, symptoms, evidence of occurrence: 
Routine CT scan showed 1.2 cm lesion in allograft and 2.0 cm lesion in native kidney.
Demonstration of imputability or root cause: 
None performed
Imputability grade: 
1 Possible
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Suggest new keywords: 
Case Report
Living donor
Kidney transplant
Kidney recipient
Kidney transplantation
Renal cell carcinoma
Therapy discussed
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Tsuboi I, Araki M, Fujiwara H, Iguchi T, Hiraki T, Arichi N, Kawamura K, Maruyama Y, Mitsui Y, Sadahira T, Kubota R, Nishimura S, Sako T, Takamoto A, Wada K, Kobayashi Y, Watanabe T, Yanai H, Kitagawa M, Tanabe K, Sugiyama H, Wada J, Shiina H, Kanazawa S, Nasu Y. Contrast-enhanced Computed Tomography-Guided Percutaneous Cryoablation of Renal Cell Carcinoma in a Renal Allograft: First Case in Asia. Acta Med Okayama. 2019 Jun;73(3):269-272. doi: 10.18926/AMO/56871. PMID: 31235976.
First review MN 5/11/22, second review CLFF 5/15/22 (agreement to text, main focus is cryosblation of Tumor in transplanted graft in order to preserve kidney function by nephronsparing tumor removal technology)
Expert comments for publication: 
The focus of the article is on the successful use of cryoablation to remove a tumor within the renal allograft, thereby sparing renal function. The tumor in the native nephrosclerotic kidney was a papillary renal cell carcinoma. However, they were unable to get sufficient tissue to diagnose the nature of the tumor in the allograft beyond confirming that it was renal cell carcinoma. In our opinion, this would most likely be a donor-derived tumor, arising post-transplant from the donor kidney cells. However, it is also possible, although unlikely, that it represented a metastasis from the tumor in the native kidney (even more unlikely is the possibility that the tumor in the native kidney represented a metastasis from a donor-origin tumor in the allograft). Finally, the possibility that it represented a slow-growing tumor present at the time of transplant cannot be excluded by definition. Nevertheless, additional studies were not performed and the focus of the article is to draw attention to the possibility of performing cryoablation in the setting of tumors arising within the allograft kidney.