Status:
Ready to upload
Record number:
1567
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:
9 years in 1 of 43 patients who received kidney grafts from donors with small renal tumors <3 cm and resected prior to transplant (see comments)
Alerting signals, symptoms, evidence of occurrence:
Analysed time interval from May 1996 to September 2007: Regular screening performed in recipients of 43 kidneys after resection of 41 renal masses prior to transplant (two kidneys represented contralateral presumably uninvolved kidneys from donors with RCC). Size range 1-2.9 cm (25 clear cell carcinoma, 5 papillary RCC, 1 chromophobe RCC, 2 oncocytoma, 5 angiomyolipoma, 3 complex/multiloculated cysts).
One tumor recurrence at 9 years posttransplant; no symptoms; patient refused therapy and lesion grew from 1.0 to 1.2 cm over 18 month interval at time of report.
Demonstration of imputability or root cause:
Tumor detected by screening; no biopsy performed.
Imputability grade:
2 Probable
Groups audience:
Suggest new keywords:
RCC (renal cell carcinoma)
Reference attachment:
Suggest references:
Brook NR, Gibbons N, Johnson DW, Nicol DL. Outcomes of transplants from patients with small renal tumors; live unrelated donors and dialysis wait-listed patients. Transpl Int 2010; 23 (5) :476 - 483
Expert comments for publication:
May be actual recurrence, at 9 years would be considered "donor-derived" as opposed to "donor-transmitted". (i.e., might represent separate de novo tumor).
Regarding the series of 43 recipients, 2 received uninvolved kidneys, 2 received kidneys with resected oncocytomas, 5 received kidneys with resected angiomyolipomas. Both oncocytomas and angiomyolipomas typically benign. Three received kidneys with resected complex multiloculated cysts with no mention of RCC. Therefore more stringent interpretation would suggest that these 12 kidneys did not harbor RCC and the actual denominator of donor kidneys with RCC is 31. The article still makes the point that this appears to be an effective strategy for transplantation of kidneys that have small resectable RCC.