Kidney Transplantation From Donors With Malignant Renal Masses: A Systematic Review.
Villani, V., et al.Clinical Transplantation 2024; 38(11): e70020.
Aims
This study aimed to synthesise the available evidence regarding the oncological and transplant outcomes of transplanting kidneys with small malignant masses.
Interventions
Revelant articles were searched using three databases including PubMed, EMBASE, and Web of Science. Studies were selected by two independent reviewers. The Newcastle–Ottawa scale was used to assess the risk of bias.
Participants
32 studies were included in the review.
Outcomes
The main outcomes of interest were patient survival, graft survival, tumor recurrence, Clavien–Dindo grade ≥ 3 complications and tumor transmission.
Follow-up
N/A
CET Conclusions
Incidental malignant tumours are an infrequent but not rare finding in donor kidneys. This systematic review synthesises the available data examining outcomes of kidney transplant using grafts with malignant masses which were resected ex-vivo. The primary outcomes included overall (OS) and graft survival, rate of recurrence and incidence of post-operative complications. 32 studies comprising 226 patients were included in the analysis. All were retrospective analyses and assessed as being of low quality. The average size of resected tumour was 12.6mm. OS and graft survival were not significantly different from those of standard kidney transplant. The recurrence rate was 2.7% with a mean follow-up of 39.9 months. The authors pointed out that this is similar to the rate of occurrence of de novo renal cell carcinoma (RCC) in all transplanted kidneys. Of the patients with recurrence, all but one were treated successfully with resection – the single cancer-related death occurred after the patient declined resection. In contrast to these encouraging outcomes, the rate of severe complication and reoperation was significantly higher than in standard transplantation. Although limited by low quality data, this review makes a compelling argument for the utilisation of donor kidneys with small incidental RCC tumours, especially with the current focus on improving organ utilisation.
Trial registration
N/A