Kidney Transplantation From Donors With Malignant Renal Masses: A Systematic Review

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-11-08 DOI:10.1111/ctr.70020

Vincenzo Villani, Rupak D. Kulkarni, Jeffrey H. Fair, Kumaran Shanmugarajah

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Abstract

Background

Small malignant renal tumors can be found in up to 1.3% of kidney donors. Several studies have investigated the use of these kidneys for transplantation, after ex vivo resection of the malignant mass.

Methods

We performed a systematic review of the literature on PubMed, Embase, and Web of Science of studies including reports of malignant renal masses excised from kidney grafts prior to transplantation. Articles including benign pathology only were excluded.

Results

Our search strategy identified 226 patients over 32 studies. Pathology included 107 clear cell carcinomas, 27 papillary renal cell carcinomas (RCCs), 84 other types of RCCs, and 8 transitional cell carcinomas. The majority of cancers were grade 1 or 2 (81.6%). Average tumor size was 12.6 mm. Clavien–Dindo ≥ 3 complication rate was 22%. Mean follow-up was 39.9 months. The 1-year, 3-year, and 5-year overall survival rate for recipients of living donor grafts was 95.8%, 92.1%, and 75.1%. The 1-year, 3-year, and 5-year living donor death-censored graft survival rate was 90.8, 85.2%, and 64.8%. Of the 226 patients, 6 (2.7%) experienced a malignant recurrence. The average time to recurrence was 36.1 months.

Conclusions

Transplantation of kidney grafts after resection of small cancerous masses is relatively safe and has low rates of recurrent malignancy. In the case of a living donor, appropriate counseling on partial nephrectomy versus donor nephrectomy should be provided, ideally by a surgeon who is not part of the transplant team. Recipients of these grafts should be carefully selected and counseled regarding the additional potential technical and oncological risks.

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恶性肾肿块供体的肾移植：系统回顾。

背景：在多达 1.3% 的肾脏捐献者中可发现小的恶性肾肿瘤。有几项研究调查了这些肾脏在体外切除恶性肿块后用于移植的情况：我们在 PubMed、Embase 和 Web of Science 上对有关移植前从肾脏移植物中切除恶性肾肿块的研究报告进行了系统性回顾。结果：我们的搜索策略在 32 项研究中发现了 226 名患者。病理结果包括107例透明细胞癌、27例乳头状肾细胞癌（RCC）、84例其他类型的RCC和8例过渡细胞癌。大多数癌症为 1 级或 2 级（81.6%）。肿瘤平均大小为 12.6 毫米。克拉维恩-丁多并发症≥3级的比例为22%。平均随访时间为 39.9 个月。活体移植物受者的 1 年、3 年和 5 年总生存率分别为 95.8%、92.1% 和 75.1%。活体移植物接受者的 1 年、3 年和 5 年存活率分别为 95.8%、92.1% 和 75.1%，活体移植物接受者的 1 年、3 年和 5 年死亡剪除存活率分别为 90.8%、85.2% 和 64.8%。在226例患者中，有6例（2.7%）恶性肿瘤复发。平均复发时间为36.1个月：结论：切除小癌块后进行肾移植相对安全，恶性肿瘤复发率较低。对于活体捐献者，应就肾部分切除术和捐献者肾切除术提供适当的咨询，最好由不属于移植团队的外科医生提供咨询。应谨慎选择这些移植物的受体，并就潜在的额外技术和肿瘤风险提供咨询。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.