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Tabbara MM, Riella J, Gonzalez J, Gaynor JJ, Guerra G, Alvarez A, Ciancio G. Optimizing the kidney donor pool: transplanting donor kidneys after partial nephrectomy of masses or cysts. Front Surg 2024; 11:1391971. [PMID: 38726469 PMCID: PMC11080618 DOI: 10.3389/fsurg.2024.1391971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
Background A limiting factor in expanding the kidney donor pool is donor kidneys with renal tumors or cysts. Partial nephrectomy (PN) to remove these lesions prior to transplantation may help optimize organ usage without recurrence of malignancy or increased risk of complications. Methods We retrospectively analyzed all recipients of a living or deceased donor graft between February 2009 and October 2022 in which a PN was performed prior to transplant due to the presence of one or more concerning growths. Donor and recipient demographics, perioperative data, donor allograft pathology, and recipient outcomes were obtained. Results Thirty-six recipients received a graft in which a PN was performed to remove suspicious masses or cysts prior to transplant. Majority of pathologies turned out to be a simple renal cyst (65%), followed by renal cell carcinoma (15%), benign multilocular cystic renal neoplasm (7.5%), angiomyolipoma (5%), benign renal tissue (5%), and papillary adenoma (2.5%). No renal malignancy recurrences were observed during the study period (median follow-up: 67.2 months). Fourteen complications occurred among 11 patients (30.6% overall) during the first 6mo post-transplant. Mean eGFR (± standard error) at 36 months post-transplant was 51.9 ± 4.2 ml/min/1.73 m2 (N = 23). Three death-censored graft losses and four deaths with a functioning graft and were observed. Conclusion PN of renal grafts with suspicious looking masses or cysts is a safe option to optimize organ usage and decrease the kidney non-use rate, with no observed recurrence of malignancy or increased risk of complications.
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Affiliation(s)
- Marina M. Tabbara
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Juliano Riella
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Javier Gonzalez
- Servicio de Urología, Unidad de Trasplante Renal, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jeffrey J. Gaynor
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Giselle Guerra
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Angel Alvarez
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, United States
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Castañeda-Millán DA, García-Perdomo HA, Alcaraz A. Is it Possible to Use Kidneys with Small Renal Masses for Transplant? A New Strategy to Face Kidney Graft Shortage for Transplantation in Ibero-America. Rev Urol 2021. [DOI: 10.1055/s-0041-1730897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Herney Andrés García-Perdomo
- Division of Urology. Department of Surgery. School of Medicine. UROGIV Research Group. Universidad del Valle. Cali, Colombia
| | - Antonio Alcaraz
- Urology and Kidney Transplantation Department. Hospital Clinic de Barcelona. University of Barcelona. Barcelona, Spain
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Branchereau J. Redefining the urologist's role in kidney transplantation. World J Urol 2020; 40:301-302. [PMID: 33175209 DOI: 10.1007/s00345-020-03520-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Julien Branchereau
- Department of Urology / Nantes University Hospital, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.
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Musquera M, Sierra A, Diekmann F, Perez M, Mercader C, Peri L, Esforzado N, Paredes D, Alcaraz A. Increasing kidney grafts for transplantation. World J Urol 2020; 39:2795-2800. [PMID: 33000340 DOI: 10.1007/s00345-020-03463-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/18/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The current pool of organs available for transplantation does not cover requirements, for this reason non-standard risk donors need to be incorporated into the pool. In this way, donors with small renal tumour are considered for transplantation after bench tumour excision. The aim of our study was to analyse our experience in using these grafts for transplantation. MATERIALS AND METHODS Retrospective analysis from our prospective accrued database of donors with incidental renal mass used for kidney transplantation between January 2007 and August 2018. RESULTS Twenty kidney transplantations were performed, thirteen cases received the affected kidney (after tumour removal) and seven the contralateral kidney; from six living and eleven deceased donors. Donor and recipient median age was 58 years (range 22-82) and 56.5 years (range 38-74), respectively. Mean tumour diameter was 12.7 mm (SD 9.5). Tumours resulted in two benign lesions and fifteen renal cell carcinoma. Surgical margins were negative. Two cases presented with bleeding after reperfusion was solved without repercussion. One case presented with immediate vein thrombosis. None of them present delayed graft function. After a 69 month follow-up none of the donors or the recipients presented tumour recurrence. CONCLUSIONS Kidneys with small incidental tumours seem to be a good option for kidney transplantation in selected patients after bench surgery excision with good functional and oncologic results. More studies and longer follow-up are needed to confirm these results.
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Affiliation(s)
- Mireia Musquera
- Hospital Clinic de Barcelona, Instituto Clínic de Nefrología y Urología, Urology, Villarroel 170, 08036, Barcelona, Spain.
| | - Alba Sierra
- Hospital Clinic de Barcelona, Instituto Clínic de Nefrología y Urología, Urology, Villarroel 170, 08036, Barcelona, Spain
| | - Fritz Diekmann
- Hospital Clinic de Barcelona, Instituto Clínic de Nefrología y Urología, Nefrology, Villarroel 170, 08036, Barcelona, Spain
| | - Meritxell Perez
- Hospital de Terrassa. Torrebonica, s/n, 08227 Terrassa, Barcelona, Spain
| | | | - Lluis Peri
- Hospital Clinic de Barcelona, Instituto Clínic de Nefrología y Urología, Urology, Villarroel 170, 08036, Barcelona, Spain
| | - Nuria Esforzado
- Hospital Clinic de Barcelona, Instituto Clínic de Nefrología y Urología, Nefrology, Villarroel 170, 08036, Barcelona, Spain
| | - David Paredes
- Hospital Clinic de Barcelona, Coordination Unit, Villarroel 170 Barcelona, 08036, Catalunya, Spain
| | - Antonio Alcaraz
- Hospital Clinic de Barcelona, Instituto Clínic de Nefrología y Urología, Urology, Villarroel 170, 08036, Barcelona, Spain
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Levine MA, Chin JL, Rasmussen A, Sener A, Luke PP. The history of renal transplantation in Canada: A urologic perspective. Can Urol Assoc J 2020; 14:372-379. [PMID: 32569569 DOI: 10.5489/cuaj.6744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
While the urologist's involvement in kidney transplantation varies from center to center and country to country, urologists remain integral to many programs across Canada. From the early days of kidney transplant to contemporary times, the leadership, vision, and skillset of Canadian urologists have helped progress the field. In this review of Canadian urologists' role in kidney transplantation, the achievements of this professional group are highlighted and celebrated. Original contributors to the field, as well as notable achievements are highlighted, with a focus on the impact of Canadian urologists.
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Affiliation(s)
- Max Alexander Levine
- Department of Surgery, Division of Urology, Multiorgan Transplant Program, Western University, London, ON, Canada
| | - Joseph L Chin
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
| | - Andrew Rasmussen
- Department of Surgery, Division of Urology, Multiorgan Transplant Program, Western University, London, ON, Canada
| | - Alp Sener
- Department of Surgery, Division of Urology, Multiorgan Transplant Program, Western University, London, ON, Canada
| | - Patrick P Luke
- Department of Surgery, Division of Urology, Multiorgan Transplant Program, Western University, London, ON, Canada
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