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Published on: March 27, 2018
Kidneys from patients with small renal tumours: a novel source of kidneys for transplantation
David L Nicol1, John M Preston, Daryl R Wall
1Renal Transplant Unit and Southern Clinical School, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia. d.Nicol@uq.edu.au
Objective:
To report the use of a novel donor source as a further option to increase the number of patients who might be able to receive a renal transplant.
Patients And Methods:
Between May 1996 and July 2007, 43 kidneys were transplanted using kidneys obtained from patients with small (<3 cm diameter) incidentally detected tumours. After bench surgery to excise the tumour, they were all successfully transplanted into patients who were elderly or had significant comorbidities.
Results:
Apart from four patients who died from unrelated illnesses, all grafts continued to function with a median and mean follow-up of 25 and 32 months. The follow-up, which included 3-monthly renal ultrasonography and chest X-rays, showed only one case of tumour recurrence, which occurred 9 years after transplantation; the patient remains stable under observation after 18 months.
Conclusions:
From our experience we consider that where nephrectomy is used for small, localized, incidentally detected renal tumours, the kidney should be considered for transplantation into carefully selected patients. Such patients with numerous medical comorbidities might benefit from renal transplantation, but not survive the waiting period if they are dependent on a deceased donor graft. Paradoxically the use of these marginal kidneys has the potential to increase the quality and length of life of these patients, despite the apparent contradiction of an intuitive principle of organ transplantation and immunosuppression.
Insights
Kidneys from donors with small tumors can be safely transplanted into elderly patients with comorbidities, offering a new option to expand the kidney donor pool. This approach can improve patient quality of life and transplant outcomes.
Area of Science:
- Nephrology
- Transplantation Surgery
- Oncology
Background:
- Renal transplantation is limited by donor organ availability.
- Patients with significant comorbidities often face long waiting times for deceased donor kidneys.
Purpose of the Study:
- To evaluate the feasibility and outcomes of using kidneys from donors with small, incidentally detected tumors for transplantation.
- To assess the potential of this novel donor source to increase the number of renal transplants performed.
Main Methods:
- A retrospective analysis of 43 kidney transplants performed between May 1996 and July 2007.
- Kidneys were obtained from donors with small (<3 cm) incidental renal tumors, followed by tumor excision.
- Transplantation was performed in elderly recipients or those with significant comorbidities.
Main Results:
- All 43 transplanted kidneys showed successful graft function.
- Median follow-up was 25 months (mean 32 months).
- Only one case of tumor recurrence was observed 9 years post-transplant; the patient remains stable.
Conclusions:
- Kidneys from donors with small, localized renal tumors are a viable option for carefully selected transplant recipients.
- This strategy can benefit patients with comorbidities who might not survive the wait for a deceased donor kidney.
- Utilizing these 'marginal' kidneys can potentially enhance both the quality and length of life for recipients.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management