Kidneys with small tumors okay for transplantation

NEW YORK (Reuters Health) - The availability of kidneys for transplantation could be increased by using kidneys removed for small, incidentally detected tumors, the results of an Australian study suggest.

The biggest challenge in kidney transplantation is the shortage of donor organs, note Dr. David L. Nicol, from Princess Alexandra Hospital in Brisbane, and colleagues. Use of "marginal" kidneys from deceased donors has been one strategy employed to address this problem, but research has shown that outcomes are generally enhanced with live donor kidneys, even from genetically unrelated donors.

For many patients, there is no suitable live donor, they explain. This is particularly problematic for older patients or those with more than one illness who may die while waiting for a donor organ from a person who has died.

Nicol's team studied the outcomes of 43 patients who received kidneys that had contained small, incidentally detected tumors.

The organs had come from 38 patients who had a kidney removed for presumed renal cell cancer and from 3 deceased donors. After surgery to remove the tumor, all the kidneys were successfully transplanted.

Most of the recipients were over 60 years and many had multiple illnesses. Four patients died from unrelated causes. All of the remaining patients had a functioning kidney during the 32 months they were followed.

Surveillance tests performed every 3 months revealed tumor recurrence in one patient. This recurrence occurred 9 years after transplantation and the patient has been stable for the last 18 months, the investigators report.

"Our experience," they conclude, "suggests that kidneys from patients with small renal tumors who have elected to undergo radical nephrectomy (removal) might provide a valuable resource for many patients with end-stage renal failure that, to date, has been largely overlooked."