Status:
Ready to upload
Record number:
2180
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
(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:
N/A: No transmissions were reported following resection of pT1a renal cell carcinomas (<4 cm diameter- 9 patients) or granular cell carcinoma (3.8 cm, 1 patient) from 10 patients who elected to undergo total nephrectomy for treatment of their disease. One recipient died of unrelated cause, and no tumor transmissions were seen with followup ranging from 32-58 months.
Alerting signals, symptoms, evidence of occurrence:
N/A
Demonstration of imputability or root cause:
N/A
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Single Center Series
Living donor
Kidney transplant
Kidney recipient
Histopathological examination
Renal cell carcinoma
Therapy discussed
Reference attachment:
Suggest references:
Ogawa Y, Kojima K, Mannami R, Mannami M, Kitajima K, Nishi M, Ito S, Mitsuhata N, Afuso H. Transplantation of Restored Kidneys From Unrelated Donors After Resection of Renal Cell Carcinoma: Results From 10 Patients. Transplant Proc. 2015 Jul-Aug;47(6):1711-9. doi: 10.1016/j.transproceed.2015.06.030. PMID: 26293039.
Note:
Uploaded MN 5/8/22
first review CLFF 5/24/22
second review MN 1/30/23
Expert comments for publication:
This is a prospective study from Japan. The authors note that over 80% of small renal tumors are treated by nephrectomy in that country, leading to about 2000 discarded kidneys per year. Given the scarcity of donor kidneys in Japan, this could represent a valuable resource. Other authors from countries in which partial nephrectomy is more common have voiced concern regarding ethical considerations for donor treatment and have underscored the need to separate the best treatment of the patient with renal cell carcinoma (i.e. partial versus total nephrectomy) from any thoughts regarding possible transplantation of the kidney. The authors of the present study also took care to separate these issues.