Status:
Ready to upload
Record number:
1920
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:
1 week posttransplant
Alerting signals, symptoms, evidence of occurrence:
Pediatric patient (3 year old) received living related kidney from father (patient had bilateral nephrectomy for treatment of Wilms' tumor). At transplant 2.5 cm mass excised from donor kidney, initially diagnosed as angiomyolipoma. One week later, final pathology report disclosed clear cell renal carcinoma, Fuhrman grade II/IV. Decision made to retain the transplant and the patient remains well and tumor free 8 years later.
Demonstration of imputability or root cause:
Tumor directly excised at time of transplant from donor organ.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest new keywords:
Donor cancer without transmission
Case report
Living donor
kidney transplant
Pediatric
Renal cell carcinoma
Reference attachment:
Suggest references:
Melgosa Hijosa M, Alonso Melgar A, Martínez Urrutia MJ, García Meseguer C, Jaureguizar Monereo E, Navarro Torres M. Living-donor transplantation after excision of unrecognized renal cancer diagnosed after transplant. Pediatric nephrology (Berlin, Germany). 2012;27(12):2319-21.
Note:
Reviewed 7/26/19; OK to upload. MN
Expert comments for publication:
Authors cite this as first pediatric example of excision of small well differentiated RCC and successful living donor kidney transplant with long term followup. Presumably the tumor was completely excised at the time of transplant, although resection margins were not commented on specifically.