Kidneys from patients with small renal tumours: a novel source of kidneys for transplantation

Abstract

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.

Expanding living kidney donor criteria with ex-vivo surgery for renal anomalies

“…Ex-vivo partial nephrectomy for incidentally discovered renal masses with subsequent renal implantation has been described previously, with several reports demonstrating its applicability to small renal cell carcinomas. 11,[15][16][17] In a study of 14 patients who underwent renal implantation after ex-vivo partial nephrectomy for small renal masses (median size 2 cm), there was no evidence of recurrence after a mean followup of 69 months. 16 Other renal masses, such as cysts, can be managed quite easily with deroofing and argon beam ablation of the inner cyst lining.…”

Infection and Cancer Screening in Potential Living Donors: Best Practices to Protect the Donor and Recipient

“…However, there have been reports of living donor renal transplants from patients with <3 cm RCC that were excised on the back table with subsequent successful transplant. In one study, out of 43 transplants performed (5 DD and 38 LD), there was only one recurrence of RCC within a transplanted kidney 9 years after the original operation [2,3]. Another group reported their living donor transplant experience from eight donors with resected RCC and eight donors with resected low-grade ureteral cancer; the group reported no recurrences of RCC and a single recurrence of ureteral cancer 15 months after the transplant [3,4].…”

Urological challenges in renal transplantation

“…After bench surgery to excise small renal tumour less than 3 cm, have been used in patients with numerous medical co-morbidities to increase the quality of life, despite the apparent contradiction of an intuitive principle of organ transplantation (70). Large cysts that occupy considerable volume of the kidney might implicate complications after transplantation due to its natural history.…”