Kidney Transplantation From Donors With Malignant Renal Masses: A Systematic Review

Small malignant renal tumors can be found in up to 1.3% of kidney donors. Several studies have investigated the use of these kidneys for transplantation, after ex vivo resection of the malignant mass.

We performed a systematic review of the literature on PubMed, Embase, and Web of Science of studies including reports of malignant renal masses excised from kidney grafts prior to transplantation. Articles including benign pathology only were excluded.

Our search strategy identified 226 patients over 32 studies. Pathology included 107 clear cell carcinomas, 27 papillary renal cell carcinomas (RCCs), 84 other types of RCCs, and 8 transitional cell carcinomas. The majority of cancers were grade 1 or 2 (81.6%). Average tumor size was 12.6 mm. Clavien-Dindo ≥ 3 complication rate was 22%. Mean follow-up was 39.9 months. The 1-year, 3-year, and 5-year overall survival rate for recipients of living donor grafts was 95.8%, 92.1%, and 75.1%. The 1-year, 3-year, and 5-year living donor death-censored graft survival rate was 90.8, 85.2%, and 64.8%. Of the 226 patients, 6 (2.7%) experienced a malignant recurrence. The average time to recurrence was 36.1 months.

Transplantation of kidney grafts after resection of small cancerous masses is relatively safe and has low rates of recurrent malignancy. In the case of a living donor, appropriate counseling on partial nephrectomy versus donor nephrectomy should be provided, ideally by a surgeon who is not part of the transplant team. Recipients of these grafts should be carefully selected and counseled regarding the additional potential technical and oncological risks.