Journal of Nephrology

, Volume 29, Issue 2, pp 163–168 | Cite as

Transplantation of kidneys with tumors

  • Giovanni M. Frascà
  • Antonia D’Errico
  • Deborah Malvi
  • Camillo Porta
  • Laura Cosmai
  • Matteo Santoni
  • Silvio Sandrini
  • Chiara Salviani
  • Maurizio Gallieni
  • Emilio Balestra


The shortage of donors in the face of the increasing number of patients wait-listed for renal transplantation has prompted several strategies including the use of kidneys with a tumor, whether found by chance on harvesting from a deceased donor or intentionally removed from a living donor and transplanted after excision of the lesion. Current evidence suggests that a solitary well-differentiated renal cell carcinoma, Fuhrman nuclear grade I-II, less than 1 cm in diameter and resected before grafting may be considered at minimal risk of recurrence in the recipient who, however, should be informed of the possible risk and consent to receive such a graft.


Renal cancer Renal transplantation Kidney donation Tumor transmission Safety of donation 



This paper was promoted by the “Onco-Nephrology Working Group” coordinated by Maurizio Gallieni under the auspices of the Italian Society of Nephrology (SIN), chaired by Giovanbattista Capasso and the Italian Association of Medical Oncology (AIOM), chaired by Stefano Cascinu.

Compliance with ethical standards


No author received any fund for the paper.

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Rees MA, Kopke JE, Pelletier RP et al (2009) A nonsimultaneous, extended, altruistic-donor chain. N Engl J Med 360(11):1096–1101CrossRefPubMedGoogle Scholar
  2. 2.
    Kidney Disease Improving Global Outcomes (KDIGO) Transplant Work Group, Kasiske BL, Zeier MG et al (2009) KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 9(Suppl 3):S89–S90Google Scholar
  3. 3.
    Abramowicz D, Cochat P, Claas FH et al (2014). European Renal Best Practice Guideline on kidney donor and recipient evaluation and perioperative care. Nephrol Dial Transplant 2014. pii: gfu216. [Epub ahead of print] ReviewGoogle Scholar
  4. 4.
    Ljungberg B, Bensalah K, Canfield S (2015) European Association of Urology (EAU) guidelines on renal cell carcinoma: 2014 update. Eur Urol 67(5):913–924CrossRefPubMedGoogle Scholar
  5. 5.
    Sener A, Uberoi V, Bartlett ST, Kramer AC, Phelan MW (2009) Living-donor renal transplantation of grafts with incidental renal masses after ex vivo partial nephrectomy. BJU Int 104:1655–1660CrossRefPubMedGoogle Scholar
  6. 6.
    Mannami M, Mannami R, Mitsuhata N et al (2008) Last resort for renal transplant recipients, ‘restored kidneys’ from living donors/patients. Am J Transpl 8(4):811–818CrossRefGoogle Scholar
  7. 7.
    Mitsuhata N, Ito S, Mannami M et al (2007) Donor kidneys with small renal cell cancer or low-grade lower ureteral cancer can be transplanted. Transplantation 83:1522–1523CrossRefPubMedGoogle Scholar
  8. 8.
    Nicol D, Fujita S (2011) Kidneys from patients with small renal tumours used for transplantation: outcomes and results. Curr Opin Urol 21:380–385CrossRefPubMedGoogle Scholar
  9. 9.
    Nicol DL, Preston JM, Wall DR et al (2008) Kidneys from patients with small renal tumours: a novel source of kidneys for transplantation. BJU Int 102:188–192CrossRefPubMedGoogle Scholar
  10. 10.
    Frank I, Blute ML, Cheville JC et al (2003) A multifactorial postoperative surveillance model for patients with surgically treated clear cell renal cell carcinoma. J Urol 170:2225–2232CrossRefPubMedGoogle Scholar
  11. 11.
    Chawla SN, Crispen PL, Hanlon AL, Greenberg RE, Chen DY, Uzzo RG (2006) The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol 175:425–431 (review) CrossRefPubMedGoogle Scholar
  12. 12.
    Crépel M, Jeldres C, Sun M et al (2010) A population-based comparison of cancer-control rates between radical and partial nephrectomy for T1a renal cell carcinoma. Urology 76:883–888CrossRefPubMedGoogle Scholar
  13. 13.
    Van Poppel H (2010) Efficacy and safety of nephron-sparing surgery. Int J Urol 17:314–326CrossRefPubMedGoogle Scholar
  14. 14.
    Van Poppel H, Da Pozzo L, Albrecht W et al (2011) A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 59:543–552CrossRefPubMedGoogle Scholar
  15. 15.
    Huang WC, Levey AS, Serio AM et al (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7:735–740CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Russo P, O’Brien MF (2008) Surgical intervention in patients with metastatic renal cancer: metastasectomy and cytoreductive nephrectomy. Urol Clin North Am 35:679–686 (review) CrossRefPubMedGoogle Scholar
  17. 17.
    Campbell SC, Novick AC, Belldegrun A et al (2009) Guideline for management of the clinical T1 renal mass. Practice Guidelines Committee of the American Urological Association. J Urol 82:1271–1279CrossRefGoogle Scholar
  18. 18.
    Piselli P, Serraino D, Segoloni GP et al (2012) Risk of de novo cancers after transplantation: results from a cohort of 7217 kidney transplant recipients, Italy 1997–2009. Eur J Cancer 49(2):336–344CrossRefPubMedGoogle Scholar
  19. 19.
    Ploussard G, Chambade D, Meria P et al (2012) Biopsy-confirmed de novo renal cell carcinoma (RCC) in renal grafts: a single-centre management experience in a 2396 recipient cohort. BJUI 109(2):195–199. doi: 10.1111/j.1464-410X CrossRefGoogle Scholar
  20. 20.
    Frascà GM, Sandrini S, Cosmai L et al (2015) Renal cancer in kidney transplanted patients. J Nephrol 28(6):659–668. doi: 10.1007/s40620-015-0219-8 CrossRefPubMedGoogle Scholar
  21. 21.
    Ison MG, Nalesnik MA (2011) An update on donor-derived disease transmission in organ transplantation. Am J Transpl 11(6):1123–1130CrossRefGoogle Scholar
  22. 22.
    Garrido G, Matesanz R (2008) The Spanish National Transplant Organization (ONT) tumor registry. Transplantation 85(8 Suppl):S61–S63CrossRefPubMedGoogle Scholar
  23. 23.
    Penn I (1995) Primary kidney tumors before and after renal transplantation. Transplant 59:480–485CrossRefGoogle Scholar
  24. 24.
    Buell JF, Beebe TM, Trofe J, Gross TG, Alloway RR, Hanaway MJ, Woodle ES (2004) Donor transmitted malignancies. Ann Transpl 9:53–56 (review) Google Scholar
  25. 25.
    Brook NR, Gibbons N, Johnson DW, Nicol DL (2010) Outcomes of transplants from patients with small renal tumors, live unrelated donors and dialysis wait-listed patients. Transpl Int 23(5):476–483CrossRefPubMedGoogle Scholar
  26. 26.
    Salgo R, Gossmann J, Schöfer H et al (2010) Switch to a sirolimus-based immunosuppression in long-term renal transplant recipients: reduced rate of pre-malignancies and nonmelanoma skin cancer in a prospective, randomized, assessor-blinded, controlled clinical trial. Am J Transpl 10(6):1385–1393CrossRefGoogle Scholar
  27. 27.
    Euvrard S, Morelon E, Rostaing L et al (2012) Sirolimus and secondary skin-cancer prevention in kidney transplantation. N Engl J Med 367(4):329–339CrossRefPubMedGoogle Scholar
  28. 28.
    Campbell SB, Walker R, See Tai S, Jiang Q, Russ GR (2012) Randomized controlled trial of sirolimus for renal transplant. American J of Transpl 12:1146–1156CrossRefGoogle Scholar
  29. 29.
    Murphy W, Grignon D, Perlman E (2004) Tumours of the kidney, bladder and related urinary structures. AFIP Atlas of Tumor Patology, vol 4. American Registry of Pathology, WashingtonGoogle Scholar
  30. 30.
    Srigley JR, Delahunt B, Eble JN et al (2013) The International Society of Urological Pathology (ISUP) vancouver classification of renal neoplasia. Am J Surg Pathol 37:1469–1489CrossRefPubMedGoogle Scholar
  31. 31.
    Penn I (1997) Transmission of cancer from organ donors. Ann Transpl 2:7–12Google Scholar
  32. 32.
    Algaba F, Arce Y, López-Beltrán A, Montironi R, Mikuz G, Bono AV (2005) European Society of Uropathology Uropathology Working Group Intraoperative frozen section diagnosis in urological oncology. Eur Urol 4:129–136CrossRefGoogle Scholar
  33. 33.
    Dechet CB, Sebo T, Farrow G, Blute MI, Engen DE, Zincke H (1999) Prospective analysis of intraoperative frozen needle biopsy of solid renal masses in adults. J Urol 162:1282–1284CrossRefPubMedGoogle Scholar
  34. 34.
    Cloix P, Martin X, Pangaud C, Maréchal J, Bouvier R, Barat D et al (1996) Surgical management of complex renal cysts: a series of 32 cases. J Urol 156:28–30CrossRefPubMedGoogle Scholar
  35. 35.
    Bielsa O, Lloreta J, Gelabert-Mas A (1998) Cystic renal cell carcinoma: pathological features, survival and implications for treatment. Br J Urol 82:16–20CrossRefPubMedGoogle Scholar
  36. 36.
    McHale T, Malkowicz SB, Tomazewski JE, Genera EM (2002) Potential pitfalls in the frozen section evaluation of parenchymal margins in nephron-sparing surgery. Am J Clin Pathol 118:903–910CrossRefPubMedGoogle Scholar
  37. 37.
    Eccher A, Boschiero L, Fior F et al (2014) Donor kidney with miliary papillary renal cell neoplasia: the role of the pathologist in determining suitability for transplantation. Ann Transpl 19:1–5CrossRefGoogle Scholar
  38. 38.
    Nalesnik MA, Woodle ES, Dimaio JM et al (2011) Donor-transmitted malignancies in organ transplantation: assessment of clinical risk. Am J Transpl 11:1140–1147CrossRefGoogle Scholar
  39. 39.
    Whang M, O’Toole K, Bixon R, Brunetti J, Ikeguchi E, Olsson CA, Sawczuk TS, Benson MC (1995) The incidence of multifocal renal cell carcinoma in patients who are candidates for partial nephrectomy. J Urol 154:968–970 (discussion 970–971) CrossRefPubMedGoogle Scholar
  40. 40.
    Klatte T, Patard JJ, de Martino M et al (2008) Tumor size does not predict risk of metastatic disease or prognosis of small renal cell carcinomas. J Urol 179:1719–1726CrossRefPubMedGoogle Scholar
  41. 41.
    Fiaschetti P, Pretagostini R, Stabile D et al (2012) The use of neoplastic donors to increase the donor pool. Transpl Proc 44(7):1848–1850CrossRefGoogle Scholar

Copyright information

© Italian Society of Nephrology 2015

Authors and Affiliations

  • Giovanni M. Frascà
    • 1
  • Antonia D’Errico
    • 2
  • Deborah Malvi
    • 2
  • Camillo Porta
    • 3
  • Laura Cosmai
    • 4
  • Matteo Santoni
    • 5
  • Silvio Sandrini
    • 6
  • Chiara Salviani
    • 6
  • Maurizio Gallieni
    • 7
    • 8
  • Emilio Balestra
    • 1
  1. 1.Nephrology, Dialysis and Renal Transplantation UnitOspedali RiunitiAnconaItaly
  2. 2.“F. Addarii” Institute of Oncology and Transplantation PathologyBologna UniversityBolognaItaly
  3. 3.Medical OncologyI.R.C.C.S. San Matteo University Hospital FoundationPaviaItaly
  4. 4.Nephrology and Dialysis UnitIstituti Ospitalieri CremonaCremonaItaly
  5. 5.Clinica di Oncologia Medica-Università Politecnica delle MarcheAnconaItaly
  6. 6.U.O. NefrologiaSpedali Civili di BresciaBresciaItaly
  7. 7.Nephrology and Dialysis UnitSan Carlo Borromeo HospitalMilanItaly
  8. 8.Department of Biomedical and Clinical Sciences “Luigi Sacco”University of MilanoMilanItaly

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