Case report: Treatment of renal cell carcinoma with partial nephrectomy in a pediatric kidney recipient (2021)

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
(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: 
12 years
Alerting signals, symptoms, evidence of occurrence: 
No symptoms, a 2.5 cm renal lesion was detected on routine renal ultrasound.
Demonstration of imputability or root cause: 
In our opinion, a small renal tumor (2.5 cm) detected 12 years after transplant (donor was 3 year old) most likely represents a de novo tumor of donor origin, since it arose in the allograft. This would be categorized as a post-transplant "donor derived" and not "donor-transmitted" tumor. The authors refer to "chimerism" of the tumor to state that donor cells were present, but do not provide further information.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Case Report
Deceased donor
Kidney transplant
Kidney recipient
Kidney transplantation
Renal cell carcinoma
Therapy discussed
donor derived
Suggest references: 
Tabbara MM, Al Nuss MA, Chandar JJ, Alperstein W, Ciancio G. Treatment of allograft renal cell carcinoma with partial nephrectomy in a pediatric kidney transplant. J Pediatr Surg Case Rep. 2021 Oct;73:102018. doi: 10.1016/j.epsc.2021.102018. Epub 2021 Aug 30. PMID: 34993052; PMCID: PMC8730291.
Uploaded 4/17/22 MN First review MN 5/11/22: I do not remember how we are classifying "donor derived" as opposed to "donor transmitted" tumors. We can discuss at the meeting. I am calling this proven, but am not sure that would be correct.The other option would be to call it excluded, which brings along its own difficulties. CLFF talked with KM - second review done by CLFF 5/16/22, see internal note. The tumor is "donor derived" & "proven", but not not transmitted. We should classify these cases as "donor derived". Internal note CLFF: we include the case, although it is only donor derived, but it is helpful to know how to preserve kidney function by "Tumor enucleation" or alternative methods. I know an unpublished case of multi-locular renal cell Ca in a pediatric recipient in the graft where the urologist removed multiple cancers (4 as R0 and 1 R1) twelve years after Kidney transplant in order to preserve renal function (2015), the kidney had already chronic rejection + compromised function and the aim was to wanted to preserve remaining kideny function as long as possible (follow up treatment by local nephrologist & urologist; one year follow up: Crea 3,2 mg/dl..return to dialysis, no tumor recurrence yet )
Expert comments for publication: 
The article focuses on the successful application of partial nephrectomy to treat a papillary renal cell carcinoma arising in the allograft kidney 12 years after transplant, with preservation of renal function. The authors discuss other therapies such as radiofrequency ablation, and point out that the tumor in this case was close to the hilum and the graft was adherent to the bowel, making this approach impractical. We would consider this a posttransplant tumor of donor origin (donor-derived) rather than a tumor present and transmitted at the time of transplant.