Status:
Ready to upload
Record number:
2326
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:
No evidence of any RCC recurrence during the median follow-up (5 years, range 2.3-11.6 years) among the 6 patients who received a kidney allograft with renal cell carcinoma following partial nephrectomy.
Alerting signals, symptoms, evidence of occurrence:
Not applicable.
Demonstration of imputability or root cause:
Not applicable.
Imputability grade:
Not Assessable
Groups audience:
Keywords:
References:
Suggest new keywords:
Malignancy
Kidney cancer, clear cell
Kidney cancer, papillary
Kidney transplant
Case series
Kidney masses
Follow up
Therapy not discussed
Renal cell carcinoma
Deceased donor
Living donor
Reference attachment:
Suggest references:
Tabbara MM, Riella J, Gonzalez J, Gaynor JJ, Guerra G, Alvarez A, et al. Optimizing the kidney donor pool: transplanting donor kidneys after partial nephrectomy of masses or cysts. Front Surg. 2024;11:1391971.
Note:
uploaded MN 7/21/24
First review AE 8/4/24
Second review MN 8/13/24
Expert comments for publication:
This paper summarizes the experience at the University of Miami from February 2009 to October 2022. 40 pathologic lesions were found in 36 kdineys that underwent partial nephroectomy prior to transplant. The most frequent diagnosis among suspicious kidney masses found at kidney procurement were benign (34/40, 85%). Among the tumors (6/40, 15%) all were low grade (5 G1, 1 G2), low stage (pT1a), most of them < 1 cm (largest renal carcinomas 1.2 and 3.2 cm), with negative margins at frozen section. Although the small sample size and tumor features are acknowledged limitations, the results are in accordance with literature evidence.
The paper offers a detailed description of the partial nephrectomy procedure and also discusses short-term surgical complications in these patients.