Kidneys from patients with small renal tumours: a novel source of kidneys for transplantation

• Published in: BJU international Vol. 102; no. 2; pp. 188 - 193
• Main Authors: Nicol, David L., Preston, John M., Wall, Daryl R., Griffin, Anthony D., Campbell, Scott B., Isbel, Nicole M., Hawley, Carmel M., Johnson, David W.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2008; Blackwell
• Subjects: Aged; Biological and medical sciences; Cadaver; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - surgery; Humans; Incidental Findings; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Kidney Transplantation - methods; Kidney Transplantation - standards; Kidneys; live donors; Living Donors; Medical sciences; Middle Aged; Nephrectomy - methods; Nephrology. Urinary tract diseases; novel donor source; Prospective Studies; renal transplantation; renal tumours; Tissue and Organ Procurement - methods; Tissue and Organ Procurement - standards; Treatment Outcome; Tumors of the urinary system; Kidney disease; Human; Nephrology; Urinary system disease; renal tumours; novel donor source; Living donor; Kidney tumor; renal transplantation; Transplantation; Kidney; Urology; Treatment; Urinary system; Surgery; Graft; live donors
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2008.07562.x

OBJECTIVE To report the use of a novel donor source as a further option to increase the number of patients who might be able to receive a renal transplant. PATIENTS AND METHODS Between May 1996 and July 2007, 43 kidneys were transplanted using kidneys obtained from patients with small (<3 cm diameter) incidentally detected tumours. After bench surgery to excise the tumour, they were all successfully transplanted into patients who were elderly or had significant comorbidities. RESULTS Apart from four patients who died from unrelated illnesses, all grafts continued to function with a median and mean follow‐up of 25 and 32 months. The follow‐up, which included 3‐monthly renal ultrasonography and chest X‐rays, showed only one case of tumour recurrence, which occurred 9 years after transplantation; the patient remains stable under observation after 18 months. CONCLUSIONS From our experience we consider that where nephrectomy is used for small, localized, incidentally detected renal tumours, the kidney should be considered for transplantation into carefully selected patients. Such patients with numerous medical comorbidities might benefit from renal transplantation, but not survive the waiting period if they are dependent on a deceased donor graft. Paradoxically the use of these marginal kidneys has the potential to increase the quality and length of life of these patients, despite the apparent contradiction of an intuitive principle of organ transplantation and immunosuppression.