Use of Kidneys with Small Renal Tumors for Transplantation: Potential benefits of organ recycling for high-risk dialysis patients

Yoshihide Ogawa¹, Keimei Kojima², Rensuke Mannami², Makoto Mannami², Keiichi Kitajima³, Mitsuo Nishi⁴, Hisaaki Afuso⁵, Seiichi Ito⁶, Naoki Mituhata⁶

¹Urology, Tokyo-West Tokushukai Hospital, Akishima, Japan, ²Urology, Uwajima Tokushukai Hospital, Uwajima, Japan, ³Urology, Kagoshima Tokushukai Hospital, Kagoshima, Japan, ⁴Urology, Saint Martin's Hospital, Sakaide, Japan, ⁵Urology, Chubu Tokushukai Hospital, Okinawa, Japan, ⁶Urology, Kure Kyosai, Kure, Japan

OBJECTIVES:  Buell, Mannami, Nicol, Masquera, and He respectively reported 14, 8, 31, 7, and 19 transplant cases using kidneys after resection of RCC. Donor-transmitted renal cell carcinoma in transplant is unavoidable but guidelines were issued to optimize organ usage. To balance the risk of dying on dialysis against cancer transmission, high-risk recipients are suggested best to deserve the procedure. Utilizing these discarded kidneys may help to suppress the rise of organ trafficking and transplant tourism. Therefore, we performed a prospective open trial that utilizes resected kidneys for transplant into third-party recipients after restoration.

SUBJECTS and METHODS:  Our clinical trial (stage 1 and 2) consisted of 5 cases each has been completed after one year of follow-up.  Donors were recruited from 6 donor-harvesting hospitals and subsequently selected from among patients who opted to undergo nephrectomy for small RCC (< 4 cm) after extensive discussion of other treatment modalities. The recipient selection was mainly based on ABO compatibility and clinical scores, and immunological data (PRA and HLA mismatch) were added to the selection criteria in the extended trial (stage 2).

RESULTS:  In the stages1 and 2, five male patients and 3 male & 2 female patients were the donors with T1a RCC, respectively. The nephrometry RENAL scores for their renal tumors were of low and moderate complexity. A total of 56 dialysis patients and 76 patients were enrolled as candidate recipients for the stages 1 and 2, respectively. Five recipients aged 47-66 and 46-65 years were selected in either stage 1 or 2, respectively. Two recipients had a history of kidney transplant in each stage. Four recipients in each stage have experienced rejection so far and the latest serum creatinine levels range from 1.10 to 5.55 mg/dl without recurrence of RCC after 17 to 43 months of follow-up.

CONCLUSIONS:  Restored kidney transplant led to achieving good renal function without recurrence of RCC at 17-43 months. The procedure appears technically demanding, however, with expertise hands selected candidates can benefit from accepting these discarded kidneys.