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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 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:
In this living donor single center case series during living donor evaluation incidental tumors were detected (n=3 out of 345, 2009-2013). After hand-assisted laparoscopic graft nephrectomy partial nephrectomy of the tumor during the back-table preparation of the graft was done (resection with 5mm margin, size: 9-25mm) and sent for pathological analysis: 2 clear cell RCC, 1 multilocular RCC (all T1a, stage 1). At the end of followup period (36 months), all recipients and donors remained free of tumor.
Alerting signals, symptoms, evidence of occurrence:
Demonstration of imputability or root cause:
Suggest new keywords:
Single Center Series
Renal cell carcinoma
Lugo-Baruqui JA, Guerra G, Chen L, Burke GW, Gaite JA, Ciancio G. Living donor renal transplantation with incidental renal cell carcinoma from donor allograft. Transpl Int. 2015 Sep;28(9):1126-30. doi: 10.1111/tri.12594. Epub 2015 May 7. PMID: 25898787.
Uploaded MN 5/8/22 first review CLFF 5/24/22 2nd review MN 5/28
Expert comments for publication:
The authors conclude: "donors with suspicious renal masses might be accepted for donations... Close follow-up protocol for monitoring of tumor recurrence is advised for both the donor and recipient.." The individuals in this series are living donors who happened to have incidental renal cell tumors at the time of donation. The authors discuss ethical issues surrounding treatment of individuals with renal cancer and immunosuppression options for recipients of the organs.