Renal cell carcinoma in renal graft recipients and donors: Incidence and consequence

introduction and Objectives: Numerous studies have reported an increasing i ncidence of small renal cell carcinoma (RCC). De novo RCC in a renal allogr aft is a rare event and has special implications in renal transplant recipi ents. The objective of this study was to retrospectively evaluate the incid ence of RCC in renal graft recipients and donors and to determine a procedu re in cases with newly detected small renal tumors at the time of kidney pr eparation before transplantation. Material and Methods: We mailed a questio nnaire to 38 German transplant clinics and received answers from 27 centers . A total of 10,997 renal graft recipients were included in the period of 1 990-1998. Results: In 30 kidneys (0.273%) RCC was detected at the time of p reparation before transplantation. There were 23 male and 3 female donors. No bilateral RCC was described. The mean age of the donors with RCC was 50. 9 years (range 37-72 years). The tumors had a mean size of 2.2 cm (range 0. 4-6 cm). 67% of the patients had a renal tumor smaller than 20 mm. In 26/27 centers the decision to transplant relies on the result of the immediate s ection for microscopic examination. 16 patients (0.145%) developed RCC 3-12 years after renal transplantation (mean 7.4 years). The mean tumor size wa s 2.5 cm (range 2-2.8 cm). In 50% a grade 1 and in the other 50% a grade 2 carcinoma was found. Conclusions: Because of the RCC incidence in donor can didates we recommend an ultrasound screening of the native kidneys before r enal explantation and an immediate preparation of the kidney surface especi ally in donors older than 45 years. In cases with small renal lesions we re commend an immediate section for microscopic examination before transplanta tion to prevent tumor implantation into an otherwise healthy patient. The f requency of RCCs after renal transplantation necessitates careful clinical and instrumental examinations in organ-transplanted recipients both before and at regular intervals after transplantation, including the patient's kid neys. Copyright (C) 2001 S. Karger AG, Basel.