Record number:
318
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:
Tumor detected at time of donation (living donor) and excised prior to transplant
Alerting signals, symptoms, evidence of occurrence:
Mother to daughter donation with normal pre-donation evaluation. A 5x5 mm nodule was found on the surface of the kidney during procurement and excised before transplantation. Histology revealed a RCC with free margins two weeks after. No transplantectomy performed. No evidence of malignancy 15 months after in donor or recipient.
Demonstration of imputability or root cause:
Direct histologic evaluation of excised lesion from donor kidney. Since this was excised prior to transplant, no actual tumor transmission occurred.
Groups audience:
Keywords:
References:
Suggest new keywords:
Case report
Living donor
Malignancy
Kidney transplant
Renal cell carcinoma
Suggest references:
AAA
Expert comments for publication:
A 5x5 mm nodule would alternatively be called an "adenoma", although the possibility of continued growth cannot be excluded. Since the tumor was excised prior to transplant, actual transmission is excluded despite the presence of tumor in the donor. The UNOS/DTAC would classify this as "intervention without disease transmission" to highlight this fact.