Case Report: Multiorgan Transplant From a Donor With RCC (2021)

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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: 
No tumors were transmitted with 32 month followup of 3 recipients (left kidney recipient following tumor excision, heart and contralateral kidney recipient, liver recipient).
Alerting signals, symptoms, evidence of occurrence: 
Demonstration of imputability or root cause: 
No tumor transmission occurred.
Imputability grade: 
0 Excluded
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Case Report
Deceased donor
Kidney transplant
Kidney recipient
Kidney transplantation
Liver transplant
Liver recipient
Liver transplantation
Heart transplant
Heart recipient
Heart Transplantation
Renal cell carcinoma
Therapy not discussed
Suggest references: 
Yang F, Jiang H, Gao X, Chen H, Zhao W, Zhu Y, Han L, Zeng L, Zhang L, Chen R. Multiorgan Transplant From a Donor With Solid Renal Masses: An Initial Experience and Clinical Considerations. Transplant Proc. 2021 Oct;53(8):2503-2508. doi: 10.1016/j.transproceed.2021.08.006. Epub 2021 Sep 2. PMID: 34482997.
Uploaded 4/17/22 MN First review MN 5/11/22; please also clone record for liver transplant, heart transplant. - OK (EP) 10/27/22 second rview
Expert comments for publication: 
This case report showed the feasibility of transplanting organs, including a kidney following resection of a small (1.4 cm) clear cell renal carcinoma, the contralateral kidney, heart, and liver. This experience is in keeping with several recent reports that have documented similar findings in larger (but still relatively small) series of patients reported to transplant registries.