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Donor kidneys with small renal cell cancers: can they be transplanted?
J F Buell1, M J Hanaway, M Thomas
1University of Cincinnati, Cincinnati, Ohio 45249, USA.
Introduction:
The purpose of this study was to determine whether incidentally discovered, small renal cell cancers (RCC) in donor kidneys can be excised and safely transplanted.
Methods:
The Israel Penn International Transplant Tumor Registry database was searched and all small RCC that were identified and resected prior to transplantation of deceased and living donor kidneys were reviewed. Patient demographics, tumor characteristics, recurrence, and survival were examined.
Results:
Fourteen kidneys were identified in which small RCC were noted at the time of procurement and where the tumors were excised ex vivo and then transplanted. Eleven kidneys were obtained from living related donors and three were from deceased donors. Median tumor size was 2 cm (range 0.5 to 4 cm). All 14 tumors were of histological Furhman grade II/VI (n = 8) or Furhman grade I/VI (n = 6). All kidneys had pathologically confirmed negative margins. The mean age of the recipients was 40.8 +/- 9.2 years, with the majority being men (11 men; 3 women). Median follow-up for this group was 69 months (range 14 to 200 months). There have been no recurrences of tumor in these recipients and the 1-, 3-, and 5-year patient and graft survivals are 100%, 100%, and 93%.
Conclusions:
These data represent the only data available (to our knowledge) on this issue. This experience indicates that donor kidneys with small, incidental RCC and low histological grade (Furhman grade I and II/IV) can be managed with excision and transplantation, with a low risk of tumor recurrence in the recipient.
Insights
Small renal cell cancers (RCC) incidentally found in donor kidneys can be safely excised and transplanted. This approach shows no tumor recurrence in recipients, demonstrating a low-risk option for kidney transplantation.
Area of Science:
- Nephrology
- Transplant Surgery
- Oncology
Background:
- Incidental small renal cell cancers (RCC) are occasionally discovered in donor kidneys.
- The safety and efficacy of transplanting kidneys with excised RCC are not well-established.
Purpose of the Study:
- To determine if donor kidneys with incidentally discovered small renal cell cancers (RCC) can be safely excised and transplanted.
- To evaluate the outcomes of kidney transplantation following RCC excision.
Main Methods:
- Review of the Israel Penn International Transplant Tumor Registry database for cases of small RCC resected from donor kidneys prior to transplantation.
- Analysis of patient demographics, tumor characteristics, recurrence rates, and survival data.
Main Results:
- Fourteen donor kidneys with excised small RCC (median size 2 cm, Furhman grade I or II) were transplanted.
- All excisions achieved negative margins.
- No tumor recurrences were observed in recipients with a median follow-up of 69 months.
- 1-, 3-, and 5-year patient and graft survival rates were 100%, 100%, and 93%, respectively.
Conclusions:
- Donor kidneys with small, incidental, low-grade (Furhman I/II) renal cell cancers can be safely transplanted after ex vivo excision.
- This strategy offers a viable option with a low risk of tumor recurrence in recipients.
- This study provides unique data on the management of RCC in donor kidneys.
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