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Record number:
1900
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:
In 97 reported cases of kidney transplant following resection of small (<4 cm) renal cancer, there were no documented recurrences. One patient developed a small lesion remote from the site of resection at 9 years post-transplant and this grew from 1.0 to 1.2 cm over a two year period, but was not biopsied. An additional 21 transplants were performed with contralateral kidneys from donors with unilateral renal cancer. There was one example of a poorly differentiated cancer arising 3 months posttransplant from a donor who had a 1.7 cm tubulopapillary tumor in the non-transplanted kidney.
Alerting signals, symptoms, evidence of occurrence:
Evaluation at procurement or during diagnostic workup (and before implantation of kidney) in all cases led to diagnosis of small RCC that was subsequently resected. In the one case with poorly differentiated cancer arising in a contralateral kidney transplanted from a donor with known papillary RCC, tumor was detected in a renal biopsy done for suspected rejection. For details see original reference (Barrou B et al. Fate of a renal tubopapillary Adenoma transmitted by an organ donor, Transplantation 2001: 72: 450)
Demonstration of imputability or root cause:
In the one case with poorly differentiated cancer arising in a contralateral kidney transplanted from a donor with known papillary RCC, tumor was detected in a renal biopsy done for suspected rejection. For details see original reference (NOTIFY record #323) (Barrou B et al. Fate of a renal tubopapillary Adenoma transmitted by an organ donor, Transplantation 2001: 72: 450)
Groups audience:
Keywords:
Suggest new keywords:
Review article
Malignancy
Kidney transplant/Kidney recipient/Kidney transplantation
Renal cell carcinoma
Deceased donor
Living donor
IWDT
Reference attachment:
Suggest references:
Yu N, Fu S, Fu Z, Meng J, Xu Z, Wang B, et al. Allotransplanting donor kidneys after resection of a small renal cancer or contralateral healthy kidneys from cadaveric donors with unilateral renal cancer: a systematic review. Clinical transplantation. 2013;28(1):8-15.
Note:
Please create new category for adverse occurence type: no harm to recipient (observed within study period).
New AO type: Risk of harm --> Donor disease without transmission (EP)
Expert comments for publication:
The authors concluded that small RCC (<4cm) with low-grade histology (clear cell Fuhrman grade I-II) are not an exclusion criterion for kidney grafts after complete resection when no increased riks for multifocal or bilateral occurence is known. They note that resection of small RCC (<4cm, R0 resection) in otherwise healthy adults is associated with a 1.5% risk of recurrence. In this review use of the contralateral kidney of a donor with RCC diagnosis was associated with a 4.8% recurrence risk (1/21). They express concern regarding this and consider this matter unresolved. They recommend that contralateral kidneys from donors with unilateral RCC not be used, especially in patients with risk factors for bilaterality, including a family history of malignancy, histologic subtype other than clear cell carcinoma, and Fuhrman grade IV lesions. (See also Council of Europe recommendations in "estimated frequency" box above).