Vital Hevia1, Rhana Hassan Zakri2, Claire Fraser Taylor3, Harman Maxim Bruins4, Romain Boissier5, Enrique Lledo6, Heinz Regele7, Klemens Budde8, Arnaldo Figueiredo9, Alberto Breda10, Cathy Yuhong Yuan11, Jonathon Olsburgh2. 1. Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain. Electronic address: vital.hevia@salud.madrid.org. 2. Department of Urology and Transplant, Guy's & St Thomas' NHS Trust Hospitals, London, UK. 3. Department of Urology and Transplant, St Georges NHS Trust Hospitals, London, UK. 4. Department of Urology, Radboudumc, Nijmegen, The Netherlands. 5. Aix-Marseille University, Marseille, France; Department of Urology & Renal Transplantation, La Conception University Hospital, Assistance-Publique Marseille, France. 6. Department of Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 7. Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria. 8. Department of Nephrology, Charité Medical University Berlin, Berlin, Germany. 9. Department of Urology and Renal Transplantation, Coimbra University Hospital, Coimbra, Portugal. 10. Department of Urology, Fundacion Puigvert, University Autonoma of Barcelona, Barcelona, Spain. 11. Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada.
Abstract
CONTEXT: Kidney transplantation is the best treatment for patients with end-stage renal disease. Incidence of small renal masses (SRMs), which most frequently are renal cell carcinomas (RCCs), is highest in patients aged >60 yr. The increasing age of donors can lead to the diagnosis of a higher number of SRMs when assessing the patient for transplantation, and so can theoretically decrease the number of kidneys suitable for transplantation. Aiming to increase the pool of kidneys suitable for transplantation, a number of studies have reported their experience using kidneys with SRMs for transplantation. OBJECTIVE: To systematically review all available evidence on the effectiveness and harm of using kidneys with SRMs as a source of transplantation. EVIDENCE ACQUISITION: A computerized bibliographic search of the Medline, Embase, and Cochrane databases was performed for all studies reporting outcomes of adult renal transplantation using kidneys with SRMs. EVIDENCE SYNTHESIS: Nineteen studies enrolling 109 patients were included and synthesized narratively. The mean recipient age was 44.2 yr, and kidneys used were retrieved from living donors in 86% (94/109) of cases. Tumor excision was performed ex vivo in all cases except for two. The vast majority of excised tumors were RCCs (88/109 patients), and clear-cell subtype was most common. The mean tumor size was 2cm (range 0.5-6.0cm) and tumor grade was G1-G2 in 93% (75/81) of patients. With a mean follow-up of 39.9 mo, overall survival rates at 1, 3, and 5 yr were 97.7%, 95.4%, and 92%, respectively, and the mean graft survival rates 99.2%, 95%, and 95.6%, respectively. Only one local relapse occurred 9 yr after transplantation, which was managed conservatively. Functional outcomes, although infrequently reported, appear to be similar to those of conventional transplants, with 1.6% of these patients needing reoperation. CONCLUSIONS: The current literature, although with low-level evidence, suggests that kidneys with excised SRMs are an acceptable source of transplantation without compromising oncological outcomes and with similar functional outcomes to other donor kidneys. PATIENT SUMMARY: Renal transplantation using a kidney with a small renal mass does not appear to increase the risk of cancer recurrence and can be a good option for selected patients after appropriate counseling and allocation.
CONTEXT: Kidney transplantation is the best treatment for patients with end-stage renal disease. Incidence of small renal masses (SRMs), which most frequently are renal cell carcinomas (RCCs), is highest in patients aged >60 yr. The increasing age of donors can lead to the diagnosis of a higher number of SRMs when assessing the patient for transplantation, and so can theoretically decrease the number of kidneys suitable for transplantation. Aiming to increase the pool of kidneys suitable for transplantation, a number of studies have reported their experience using kidneys with SRMs for transplantation. OBJECTIVE: To systematically review all available evidence on the effectiveness and harm of using kidneys with SRMs as a source of transplantation. EVIDENCE ACQUISITION: A computerized bibliographic search of the Medline, Embase, and Cochrane databases was performed for all studies reporting outcomes of adult renal transplantation using kidneys with SRMs. EVIDENCE SYNTHESIS: Nineteen studies enrolling 109 patients were included and synthesized narratively. The mean recipient age was 44.2 yr, and kidneys used were retrieved from living donors in 86% (94/109) of cases. Tumor excision was performed ex vivo in all cases except for two. The vast majority of excised tumors were RCCs (88/109 patients), and clear-cell subtype was most common. The mean tumor size was 2cm (range 0.5-6.0cm) and tumor grade was G1-G2 in 93% (75/81) of patients. With a mean follow-up of 39.9 mo, overall survival rates at 1, 3, and 5 yr were 97.7%, 95.4%, and 92%, respectively, and the mean graft survival rates 99.2%, 95%, and 95.6%, respectively. Only one local relapse occurred 9 yr after transplantation, which was managed conservatively. Functional outcomes, although infrequently reported, appear to be similar to those of conventional transplants, with 1.6% of these patients needing reoperation. CONCLUSIONS: The current literature, although with low-level evidence, suggests that kidneys with excised SRMs are an acceptable source of transplantation without compromising oncological outcomes and with similar functional outcomes to other donor kidneys. PATIENT SUMMARY:Renal transplantation using a kidney with a small renal mass does not appear to increase the risk of cancer recurrence and can be a good option for selected patients after appropriate counseling and allocation.
Authors: Alberto Piana; Iulia Andras; Pietro Diana; Paolo Verri; Andrea Gallioli; Riccardo Campi; Thomas Prudhomme; Vital Hevia; Romain Boissier; Alberto Breda; Angelo Territo Journal: Asian J Urol Date: 2022-06-10