Can urologic oncologists help expand the renal donor pool with “restored” kidneys?

Cohn, Joshua A.; Englesbe, Michael J.; Wolf, J. Stuart

doi:10.1016/j.urolonc.2008.08.007

Cited by 5 publications

(3 citation statements)

References 7 publications

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“…For patients with small renal cancer, current evidence shows that partial nephrectomy, as compared to radical nephrectomy, provides equivalent oncologic outcomes with optimal preservation of renal function; however, a large proportion of patients with small renal cancer choose to undergo radical nephrectomy for various reasons. It is estimated that as many as 8000 to 10 000 cases of small renal cancer are treated by radical nephrectomy in the United States each year [26]. Currently, almost all of these resected kidneys with small renal cancer are discarded.…”

Section: Discussionmentioning

confidence: 99%

Benign and Malignant Renal Cells Are Differentially Inhibited during Prolonged Organ Preservation

Fu²,

Liu³

et al. 2013

PLoS ONE

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The worry of potential residual renal cancer cells in donor kidney after resection of small renal cancer impedes the extensive use of such controversial donor source. To explore the impacts of organ preservation process on the survival of renal cancer cells, we detected cell proliferation and viability of benign and malignant renal cell lines and clinical renal samples after treated with simulated organ preservation process. It was found that the viability and proliferation of malignant renal cells are inhibited much more than that of benign renal cells during prolonged organ preservation. The inhibition of proliferation in benign renal cells is fully reversible, while in malignant renal cancer cells is not fully reversible after a certain time. So potential residual renal cancer cells could be partly inhibited and eliminated by organ preservation process.

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Section: Discussionmentioning

confidence: 99%

Benign and Malignant Renal Cells Are Differentially Inhibited during Prolonged Organ Preservation

Fu²,

Liu³

et al. 2013

PLoS ONE

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“…Many pioneers have advocated the implementation of this novel source for kidney transplantation [19–22,25,41–44]. Cohn et al have campaigned a decade ago: ‘We encourage urologic oncologists to open discussions with transplant surgeons about considering transplantation of kidneys after ex vivo excision of small renal masses, from very selected donors (who prefer radical to partial nephrectomy) and into very selected (high‐risk) recipients’ [42]. From our study and literature review, the tumour recurrence is in fact a very rare event after ex vivo tumour excision for transplantation, despite the recipients were under immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcome of kidney transplant by using restored kidney grafts after tumour ex vivo excision – a prospective study

Mou

et al. 2020

Transpl Int

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The aim of this study is to report long-term outcomes of kidney transplantation by using the kidney graft after a small tumour ex vivo excision. A structured programme was established to use the restored kidney graft from urological referral after radical nephrectomy. The criteria were defined as tumour size ≤3 cm, margin clear on frozen section and recipients aged ≥60 years or those on the urgent list for transplantation as a result of imminent lack of dialysis access. The recipients were followed up regularly for surveillance of tumour recurrence. Between February 2007 and February 2018, 28 recipients had kidney transplantation by using the restored kidney grafts. The tumour size was 2.6 AE 0.7 cm. The follow-up was median 7 years without evidence of tumour recurrence. The patient and graft survival was satisfactory. Kidney transplantation by using restored kidneys after a small tumour excision is a novel source for selected recipients. The long-term patient and graft survival is satisfactory. Although there is a risk of tumour recurrence, it is rare event. Together with literature review, we would support use of kidney graft after a small tumour excision for selected recipients.

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“…While this was favorable for the two recipients that received kidneys with benign disease, and absolved the two donors of future concern of renal cancer; it points out the imprecision of radiographic diagnosis alone, and the over treatment that would result from pushing patients with small renal tumors to donate their kidney. Cohen et al (33) described two potential donors that had an SRM detected on imaging studies during their kidney donor evaluation. In these cases the corresponding recipients elected not to receive the tumor bearing kidney, and the potential donors underwent a curative partial nephrectomy.…”

Section: Patients Who Have a New Srm Detected During Living Kidney Domentioning

confidence: 99%

The Use of Kidneys with Small Renal Tumors for Transplantation: Who Is Taking the Risk?

Flechner

Campbell

2012

American Journal of Transplantation

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The ever-increasing disparity between the number of organs available for transplant and the need for organs drives further exploration into the use of compromised or marginal donors. There is now an emerging advocacy for the use of kidneys with existing tumors, which may be rendered tumor free after surgical excision and reconstruction. This practice is based on reliable data that renal cancers <3 cm in diameter behave with minimal malignant potential and likelihood of transmission to the immunosuppressed recipient. However, in the case of live donors this creates a potential ethical conflict between those treating patients with renal masses and those with an interest in renal donation. The best available treatment for patients with a small renal tumor is a form of nephron-sparing tumor excision or ablation, as this approach provides for the maximum amount of residual kidney function and enhances survival. Thus, patients newly diagnosed with small renal tumors should be referred to centers with expertise in nephron sparing techniques, not transplant centers. In the case of an individual undergoing a live donor evaluation in which a small renal tumor is detected, a careful analysis of risk and benefit for the potential donor and the recipient is indicated.

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Can urologic oncologists help expand the renal donor pool with “restored” kidneys?

Cited by 5 publications

References 7 publications

Benign and Malignant Renal Cells Are Differentially Inhibited during Prolonged Organ Preservation

Benign and Malignant Renal Cells Are Differentially Inhibited during Prolonged Organ Preservation

Long‐term outcome of kidney transplant by using restored kidney grafts after tumour ex vivo excision – a prospective study

The Use of Kidneys with Small Renal Tumors for Transplantation: Who Is Taking the Risk?

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