Record number:
321
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
(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 edn) 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 edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered low-risk; RCC > 4-7 cm (stage T1b AJCC 8th edn) and WHO/ISUP grade I/II (Fuhrman grade I/II) are considered intermediate-risk; RCC > 7 cm (stage T2 AJCC 8th edn) 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 edn) 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 un¬involved 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 [159] 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:
108 months in one of 43 patients
Alerting signals, symptoms, evidence of occurrence:
small lesion detected by US, 9 years after transplanting a kidney with an excised small tumour (follow-up with 3 monthly US of the allograft and chest X-rays in addition to standard medical review and investigations). The lesion was detected in the graft but far remote from the initial tumour-resection site.
Demonstration of imputability or root cause:
Not mentioned.
Imputability grade:
Not Assessable
Groups audience:
References:
Suggest new keywords:
malignancy
single center series
kidney transplant
Renal cell carcinoma
Suggest references:
AAA
Expert comments for publication:
Important independent report of the use of pre-transplant excision of small RCC allowing subsequent use of kidneys for transplantation. The one patient (of 43) that had tumor 9 years post-transplant could represent a de novo tumor and not recurrence of original tumor, though this is arguable.