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

Abstract

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.

Utility of MRI in the Characterization of Indeterminate Small Renal Lesions Previously Seen on Screening CT Scans of Potential Renal Donor Patients

“…In our study, we identified two lesions that were categorized as indeterminate lesions by CT but were designated angiomyolipomas by MRI, a reclassification that directed surgical management in both cases. Given the organ shortage, some authors have proposed the use of donor kidneys from patients with renal tumors less than 3 cm; these tumors are excised during backbench preparation of the graft [22,23]. Excision of such tumors, including angiomyolipomas, does not seem to affect graft or recipient survival [24,25].…”

Living donor renal transplantation with incidental renal cell carcinoma from donor allograft

“…The use of renal grafts from donors with extra‐renal malignancies diagnosed at the time of organ procurement has been extensively reviewed before . Desai et al .…”

“…The use of renal grafts from donors with extra-renal malignancies diagnosed at the time of organ procurement has been extensively reviewed before [5]. Desai et al updated the risk of cancer transmission from donors characterized as high or unacceptable risk from the cancer registry data.…”

“…Flechner and Campbell also reviewed the use of kidneys with small renal tumors for transplantation [5]. They considered that live donors create a potential ethical conflict between those treating patients with renal masses and those with an interest in renal donation.…”

Marginal Donors in Renal Transplantation

“…Kidneys with incidental small renal cell carcinomas (less than 3 cm) in living marginal donors can be considered suitable grafts after ex vivo tumorectomy [51,52]. Buell et al [53] reported 14 kidney transplantations after tumorectomy, with no cancer development in the recipient in a follow-up period of 2 to 17 years after renal transplantation.…”