Portal de Periódicos da CAPES

Donor Kidneys With Small Renal Cell Cancer or Low-Grade Lower Ureteral Cancer Can Be Transplanted

2007; Wolters Kluwer; Volume: 83; Issue: 11 Linguagem: Inglês

10.1097/01.tp.0000268482.48076.22

1534-6080

Naoki Mitsuhata, Seiichi Ito, Makoto Mannami, Keimei Kojima, R. Mannami, Mitsuo Nishi,

Organ Donation and Transplantation

The shortage of donor organs is a world-wide phenomenon. In Japan deceased organ donation traditionally has not occurred. The great majority of kidneys for transplantation come from living donors. Because of the great shortage of donor organs from living or deceased donors, it is important to use all sources of transplantable kidneys. We report here four cases of successful renal transplantation using kidneys from donors with renal or lower ureteral cancers. The four donors were patients in other hospitals. Donor patients and their families were informed about the therapeutic options based on the strict standard urological criteria. They all consented on the resection and possible donation if the donor kidneys were medically usable. One kidney with a clear cell adenocarcinoma, G1⊃G2, pT2, 3.5 cm in diameter was surgically removed and the tumor was excised on the back table. Lower ureteric cancers were excised from three kidneys. The margins of the remaining ureters were cancer free as determined by frozen section. Histological examination of these three ureters revealed transitional cell carcinoma (TCC), G1⊃G2, pT1: TCC, G3, pT2: TCC, G2, pT2, respectively. The extirpated organs were perfused with University of Wisconsin solution after removal from the patients and stored after the cancers were excised. The recipients and their families were fully informed about the possible risk of recurrence of cancer, and they all consented to have transplantation. The donor kidneys were transported to Kure Kyosai Hospital where transplantation was performed. The operations were done in November of 1997 and in March, July, and September of 2001. The donors' ages ranged from 62 to 74 years, and the recipients were 42 to 56 years old. One patient had previously had two kidney transplants; the other three had one prior transplant. All received healthy kidneys from related donors, but were on hemodialysis due to rejection at the time of our operation. After transplantation, all cases developed humoral or cellular rejection reactions of various degrees. The rejections were overcome by plasma exchange, monoclonal antibody (Orthoclone OKT3), and/or steroid pulse therapy. The recipients were followed up carefully at our outpatient clinic after surgery. All survived for more than 62–109 months without any sign of cancer recurrence. Their creatinine levels were stable (range: 1.5–2.8 mg/dl). All recipients are physically and mentally healthy with gratitude to the unknown donors. One donor was lost to follow up. The other three are alive and cancer free. In the literature, we found reports about patients who received renal transplants after resection of localized cancer from the donors' kidneys (1, 2). A study was done on cancer transmission by cardio-pulmonary grafts from cancer-carrying donors (3). Kidney transplantation using kidneys with lower ureteric cancers have not previously been reported. Our letter suggests that 1) the kidneys with small renal cancer and low-grade lower ureteral cancer may be used for transplantation, 2) the chronic shortage of donor kidneys may be alleviated by widespread application of our approach. Naoki Mitsuhata Seiichi Ito Department of Urology Kure Kyosai Hospital Hiroshima, Japan Makoto Mannami Keimei Kojima Rensuke Mannami Department of Urology Uwajima Tokushukai Hospital Uwajima, Japan Mitsuo Nishi Department of Urology Kagawa Rosai Hospital Marugame, Japan