| Article ID | Journal | Published Year | Pages | File Type |
|---|---|---|---|---|
| 6247148 | Transplantation Proceedings | 2015 | 9 Pages |
â¢Ten restored nephrectomized donor kidneys with small-cell carcinoma were transplanted.â¢Over 32- to 58-month follow-up, 9 grafts were functioning with no tumor recurrence.â¢Restored kidneys with small tumors may be suitable for high-risk transplantation patients.
PurposeTo relieve the chronic shortage of donor kidneys, we conducted a prospective kidney transplantation trial using kidneys removed from 10 unrelated patients (51 to 79Â years of age) who had undergone nephrectomy for small renal cell carcinoma (1.5 to 3.9Â cm) of low-to-moderate complexity based on RENAL (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior/posterior location relative to polar lines) nephrometry (objective description helpful for operative indication and planning).MethodsDonors were selected from among 15 patients who opted to undergo nephrectomy for small renal cell carcinoma. A total of 76 dialysis patients 34 to 85 years of age who agreed to undergo restored kidney transplantation were recruited as transplant candidates.ResultsIn stage 1 (5 cases), high-risk patients were selected without human leukocyte antigen testing, and accelerated acute rejection occurred in 4 of 5 recipients. This trial was subsequently extended with human leukocyte antigen testing, and an additional 5Â patients were enrolled in stage 2. Eight recipients, including 4 recipients with a history of renal transplantation, experienced rejection; 1 patient resumed dialysis 35 months after transplantation. The most recent serum creatinine levels ranged from 1.10 to 3.19Â mg/dL in the 9 recipients with functioning grafts and from 0.84 to 4.68Â mg/dL in the 10 donors. No tumor recurrence was noted at 32 to 58 months after surgery in either the recipients or the donors.ConclusionsRestored kidney transplantation using kidneys with a small renal tumor seems suitable for carefully selected high-risk recipients and, in particular, elderly kidneys can also function well. Avoiding cancer transmission, fair recipient selection, close follow-up, and a well-organized tracking system warrant further study.
