CAN DONOR KIDNEYS WITH SMALL RENAL CELL CANCERS BE SAFELY TRANSPLANTED?

Abstract

P851 Occasionally transplant surgeons are presented with the clinical dilemma of an intra-operative discovery of an unsuspected small renal mass in the donor organ when the recipient surgery is already in progress. Little data exists regarding the risk of using donor kidneys with small renal cell tumors. Moreover, controversy exists in the literature (2 case reports, 8 patients total) over whether small renal cell cancers actually represent adenomatous or frankly malignant lesions. The purpose of this study was to evaluate the risk of malignancy transmission of small renal cell cancers that are excised ex vivo and transplanted. Methods: All cases of donors with small renal cell cancers identified and resected prior to transplantation were reviewed. Patient demographics, tumor characteristics, recurrence, and survival were examined. Results: Fourteen kidneys were identified in which small renal cell tumors were noted after procurement, where the tumors were excised ex vivo and then transplanted. Eleven kidneys were obtained from living-related donors and three were from cadaveric donors. Median tumor size was 2 cm (range 0.5 to 4 cm). All fourteen tumors were of histologic Furhman grade II/VI (n=8) or Furhman grade I/VI (n=6). All kidneys had pathologically confirmed negative margins. The mean age of the recipients was 40.8 ± 9.2 years, with the majority being male (11M; 3F). Median follow-up for this group was 69 months (range 14 to 200 months). There have been no recurrences of tumor in these recipients and the 1, 3 and 5-yr patient and graft survival was 100%, 100% and 93. Conclusions: In this small, yet relatively large experience compared to the existing literature, donor kidneys with small unsuspected renal cell cancers and low histological grades (Furhman grade I and II/IV) can be managed with partial nephrectomy, then transplanted with a low risk of donor malignancy transmission.