Status:
Ready to upload
Record number:
2188
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
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- no tumor transmissions occurred (in reipients of other organs from these donors; during the study period kidneys with mass lesions were not transplanted).
Alerting signals, symptoms, evidence of occurrence:
Renal mass lesions detected at the time of organ procurement.
Demonstration of imputability or root cause:
N/A
Groups audience:
Keywords:
References:
Suggest new keywords:
Malignancy
Single center Series
Deceased donor
Kidney transplant
Histopathological examination
Renal cell carcinoma
Therapy not discussed
Reference attachment:
Suggest references:
Ambrosi F, Ricci C, Malvi D, Cillia C, Ravaioli M, Fiorentino M, Cardillo M, Vasuri F, D'Errico A. Pathological features and outcomes of incidental renal cell carcinoma in candidate solid organ donors. Kidney Res Clin Pract. 2020 Dec 31;39(4):487-494. doi: 10.23876/j.krcp.20.050. PMID: 32855366; PMCID: PMC7770991.
Note:
upload MN 5/8/22
first review CLFF 5/23/22
second review MCS 08/14/24
Additional review MN 8/16/24: please clone this record for MPHO type-> kidney -- OK done (EP)
Expert comments for publication:
This single center (University of Bologna, Italy) retrospective series covers 32 renal mass lesions detected in 1321 donors during the period 2001-2017. Importantly, none of the kidneys containing masses were used for transplant; the report documents the absence of tumor transmission in the recipients of other organs from these donors (17 livers, 6 contralateral kidneys, 2 hearts, 1 lung).
20 of the renal masses were renal cell carcinomas, 6 were angiomyolipomas, and 6 were benign lesions (5 oncocytomas, 1 papillary adenoma). Renal carcinomas ranged from 0.3-3.2 cm diameter. Recipient followup time ranged from 32-164 months (mean followup 88 months).
The authors highlight the low transmission risk in cases of pT1a clear cell and papillary renal cell carcinomas.They comment on limitations during the study period related to a non-standardized approach to resection of renal tumors that may either make pathologic frozen section evaluation suboptimal or preclude subsequent use of the kidney for transplant, and recommend wedge resection to include the entire lesion for evaluation at the time of transplant.