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Ready to upload
Record number:
2184
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
- The authors observe that the risk of renal cell carcinoma in kidney recipients is approximately 5-10 times higher than the general population, but further note that about 90% of these arise in the native kidneys (in contrast to donor transmitted cancer), and that large cohort studies identify renal cell carcinoma in less than 1% of kidney recipients.
- The following is the 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.
Time to detection:
Not applicable
Alerting signals, symptoms, evidence of occurrence:
Not applicable
Demonstration of imputability or root cause:
Not applicable
Imputability grade:
Not Assessable
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Review article
Deceased donor
Kidney transplant
Renal cell carcinoma
Therapy discussed
Reference attachment:
Suggest references:
Dahle DO, Skauby M, Langberg CW, Brabrand K, Wessel N, Midtvedt K. Renal Cell Carcinoma and Kidney Transplantation: A Narrative Review. Transplantation. 2022 Jan 1;106(1):e52-e63. doi: 10.1097/TP.0000000000003762. PMID: 33741842; PMCID: PMC8667800.
Note:
uploaded MN 5/8/22
first review MN 5/6/24
second review KM 7/2/24
Expert comments for publication:
This narrative review deals with the overall topic of kidney tumors and kidney transplantation. As such, it discusses both recipient origin and donor-transmitted neoplasia. The focus is predominantly on treatment options in the transplant setting. Options including partial/total nephrectomy, ablation procedures, immunosuppression reduction and use of mTOR inhibitors, tyrosine kinase inhibitors, and immune checkpoint inhibitors are discussed. The authors note that no specific guidelines for renal cancer treatment in this patient population exist. They also refer to a separate review highlighting a high (~40%) frequency of significant rejection episodes (71% with graft failure) in solid organ recipients with other tumors treated with immune checkpoint inhibitors (d'Izarney T et al. Am J Transplant 2020; 20;2457-65). The authors additionally present their own algorithms for the treatment of renal cell cancer in the kidney recipient, use of organs from donors with renal cell cancer (similar to Council of Europe guidelines), evaluation of transplant candidates for renal cell cancer, and screening for renal cell cancer in transplant recipients.