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Record number:
2102
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
N/A. The editorial discusses issues surrounding patients who have small renal cancers, including both those who present for treatment and those who have a small tumor discovered during evaluation for living kidney donation. The overall frequency of new cases of renal cell carcinoma is given as 52,000 cases per year in the USA.
(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:
N/A
Alerting signals, symptoms, evidence of occurrence:
N/A
Demonstration of imputability or root cause:
N/A
Groups audience:
Keywords:
Suggest new keywords:
Malignancy
Editorial
Deceased donor
Living donor
Kidney transplant
Kidney recipient
Kidney transplantation
Renal cell carcinoma
Therapy discussed
Reference attachment:
Suggest references:
Flechner SM, Campbell SC. The use of kidneys with small renal tumors for transplantation: who is taking the risk? Am J Transplant. 2012;12(1):48-54.
Note:
First review 5/9/22 MN
second review 5/19/22 CLFF (for Kerstin): comment: OPO should have fields for structured data collection of tumors in their donors - we implemented this in Germany since 4/14/2020 to guide coordinators, transplant physicians etc. - by this we can readout the outcomes well (the same for living donors, which must be registered at Eurotransplant) -> then we know and can conclude more.
Expert comments for publication:
This thoughtful editorial discusses various scenarios at the intersection of the patient with a small renal cancer and the current shortage of available kidneys for transplant. The authors argue that the treatment of choice for a small renal cell carcinoma is partial nephrectomy (or similar local approach such as cryotherapy or radiofrequency ablation) and not total nephrectomy. Total nephrectomy does not offer increased tumor survival benefits and has an increased risk of subsequent morbidity and mortality from chronic kidney disease and associated conditions (e.g. cardiovascular disease). Therefore these patients should be offered treatment and not referred for total nephrectomy to facilitate organ donation. A separate category of patients have small renal cancers discovered during evaluation for previously planned live kidney donation. The options and potential outcomes and complications of partial versus complete nephrectomy should be thoroughly discussed with the potential donors. Kidneys from deceased donors with incidentally discovered small and well differentiated renal cancers can be used for transplant following tumor resection, but informed consent and adequate followup of the recipient is necessary. Finally, given the small numbers of such transplants, the authors argue for a central repository of information of all such cases to aid in understanding long term outcomes and to define favorable and unfavorable characteristics of small tumors that can refine the selection process.