Ann Surg Treat Res.  2017 May;92(5):361-364. 10.4174/astr.2017.92.5.361.

Experiences of renal transplants from donors with renal cell carcinoma after ex vivo partial nephrectomy

• Lim SY
• Kim MG
• Park KT
• Jung CW

• KMID: 2377707
• DOI: http://doi.org/10.4174/astr.2017.92.5.361

Abstract

PURPOSE
Routine evaluation of kidney donors occasionally reveals an incidental renal mass with an otherwise satisfactory kidney function. The use of such a kidney with an enhancing mass for transplantation is a matter of debate owing to a possible risk of transmission of donor malignancies. We report our experience of kidney transplants from donors with renal cell carcinoma, after ex vivo resection of the renal mass.
METHODS
Two women aged 44 and 56 years were diagnosed with enhancing renal masses measuring 0.9 cm and 0.7 cm, respectively, during donor evaluation for kidney transplantation. Both patients and their families were informed of a potential risk of recurrent renal cell carcinoma following transplantation.
RESULTS
Renal function test results of both donors satisfied the living donor selection criteria. Laparoscopic live donor nephrectomy was performed with ex vivo resection of renal masses on the bench table. Immediate pathological analysis revealed a renal cell carcinoma with a margin of normal renal parenchyma before transplantation. Regimens based on mammalian target of rapamycin inhibitors, which are known for their antitumoral properties, were used for immunosuppression in both recipients. None of the recipients showed recurrence or metastasis during the follow-up period, which was longer than 3 years after transplantation.
CONCLUSION
In light of the ongoing shortage of kidney donors, kidneys with small renal cell carcinoma could be considered for transplantation after appropriate removal of the lesion, with a very low risk of recurrent disease.

Keyword

Kidney transplantation; Renal cell carcinoma; Nephrectomy

MeSH Terms

Carcinoma, Renal Cell*
Female
Follow-Up Studies
Humans
Immunosuppression
Kidney
Kidney Transplantation
Living Donors
Neoplasm Metastasis
Nephrectomy*
Patient Selection
Recurrence
Sirolimus
Tissue Donors*
Sirolimus

Figure

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  Fig. 1 (A) Transverse abdominal computed tomography angiogram of the 44-year-old kidney donor shows 0.9 cm tumor in the mid pole of the right kidney (arrow). (B) Coronal abdominal computed tomography angiogram of the 56-year-old kidney donor shows 0.7 cm tumor in the lower pole of the right kidney (arrow).

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