Can We Use Kidney Grafts With Small Neoplastic Lesions?

Abstract

INTRODUCTION The widening gap between kidney transplant demand and supply prompted the expansion of selection criteria for donation to increase the available donor pool. Among donors with expanded criteria are even those with small renal cancers. We report our experience on transplantation of kidneys with small renal neoplasm. MATERIALS AND METHODS. We accidentaly found, at bench surgery time pre-transplantation, six suspected neoplastic lesions on donor kidney. All lesions were excised and histological analyzed by frozen sections. Results were confirmed in permanent sections and staged with Fuhrman nuclear grade. Following cancer diagnosis surgical excision was enlarged with achievement of free resection margins. After informed consent all grafts except one were used for transplantation. RESULTS. Histological lesions type were: three cystic renal cell carcinoma (RCC), two papillary RCC and one oncocytoma. We not utilized one of the graft with papillary RCC for the presence of multifocality. We transplanted the other five kidneys and contralateral kidney of papillary RCC. Table 1 shows donors, recipients and neoplastic characteristics. All recipients were treated with CNI based immunosuppressive regimen and at mean follow-up of 63 months (min 25, max 144) have functioning grafts and no signs of neoplastic disease. One patient died two years after transplant for cardiovascular event.Table: No Caption available.DISCUSSION. In our experience, kidneys with small tumors (T1a) can be used for transplantation. It is mandatory, in order to ensure to recipients an acceptable level of risk, carefull evaluation of histological type and grading of neoplastic disease, free resection margins and strict follow up.