Case report: Renal Cell Carcinoma (2001)

Record number: 
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: 
7 months
Alerting signals, symptoms, evidence of occurrence: 
Barrou: Left kidney recipient rejected all residual tumoral cells after graft removal and immunosuppression discontinuation. Diagnosed soon after Tx. Kidney recipient: diagnosed by kidney biopsy with an infiltrating renal carcinoma, poorly differentiated. Enlarged lymph nodes along illiac vessels. Alive after nephrectomy.
Demonstration of imputability or root cause: 
Barrou: Condition present in the donor (17-mm tubulopapillary adenoma in the right kidney). Right kidney not transplanted. Left kidney and liver transplanted. Fuhrman I-II, found on the right kidney, which was not transplanted. Contralateral kidney, liver and heart transplanted. At least two recipients affected. HLA typing of tumoral cells in kidney recipient revealed tumor origin.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
case report
kidney transplant
Renal cell carcinoma
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Expert comments for publication: 
I have difficulty with this report. The donor had a well differentiated tubulopapillary carcinoma, but the recipient developed an extensive poorly differentiated renal cell carcinoma of donor origin a few months posttransplant. To attribute this to the tubulopapillary carcinoma seems to run counter to the typical behavior of RCC and suggests to me that it might have represented a separate donor renal tumor that was undetected at time of transplant. Notably, the tumor in tthe recipient was undetectable by ultrasound even at the time of clinical deterioration. I have a hard time accepting the conclusion that the larger literature, supporting the point of view that small RCC can be safely excised with subsequent transplant, is invalid based on this report. Nevertheless, the observation itself is valid and continued experience will define the optimal approach.