Renal Transplantation After Renal Tumour Excision: A Systematic Review.: Abstract# 2913

PURPOSE: Availability of renal transplantation is limited by an inadequate supply of organs. Worldwide, there is an expanding population of patients being maintained on dialysis. To increase the supply of donors to meet this demand, renal transplantation using ‘restored’ kidneys following excision of renal tumours has been proposed. In this systematic review, we aim to collate and evaluate the published evidence for this novel approach. METHODS: A literature search of databases (MEDLINE and EMBASE) was undertaken to identify published studies of renal transplantation after renal tumour excision, focusing on selection criteria, operative strategy, tumour recurrence and graft and patient survival outcomes. RESULTS: Nine case series and 8 case reports were included for review. A total of 125 patients underwent renal transplantation using grafts restored following excision of renal tumours. Eighty-nine percent (111/125) of grafts were from live donors. Thirteen of 17 studies reported intraoperative frozen section of the excised renal tumour prior to renal transplantation. Eighty-four percent (105/125) were proven to be malignant renal cell carcinoma (RCC) on pathology. Ninety-nine percent (104/105) of these RCC were less than 4 cm in size. Fourteen studies reported tumour margin status, all of which were negative. Sixteen studies reported follow-up time; the median value was 56(15-138) months. Fourteen studies reported graft outcomes; 5(4%) patients lost their grafts and returned to dialysis. All 17 studies reported patient survival outcomes, and 13(10%) patients died with a functioning graft. Of the total 105 patients with renal transplants after excision of RCC, there was one recurrence in the graft kidney at 9 years. CONCLUSIONS: Current evidence suggests that renal transplantation using kidneys after renal tumour excision is safe and feasible in selected patients with end-stage renal failure. Future studies are required to further define the selection criteria for the donor kidneys and the renal transplant recipients.