Wiley logoUS surgeons at the University of Maryland School of Medicine in Baltimore claim to have successfully conducted kidney transplants after eliminating tiny cancerous and benign masses from the donated organs. Patients with end-stage renal disease could possibly be presented with a critical lifeline through this technique. In addition, it may also surge the supply of vital organs.

During the regular donor evaluation, five renal masses were apparently uncovered. They ranged from 1.0cm to 2.3cm in size. While two of the five were found to be benign, cancerous cells were discovered in three of the others.

“Transplanting a living donor kidney which has been affected by a renal mass is controversial and considered a high risk” mentioned co-author Dr Michael W Phelan. “However the ongoing shortage of organs from deceased donors, and the high risk of dying while waiting for a transplant, prompted five donors and recipients to push ahead with surgery after the small masses were found in the donor kidneys.”

After removing the kidneys from the donors, the surgeons placed them on ice and took them to the recipients’ operating rooms. Following this, they appeared to have carefully removed the renal mass along with a portion of the tissue close to the mass which was then rushed to the pathology. Here, the experts confirmed whether the tumor had been completely removed. The surgeons then revealed to have reconstructed and transplanted the kidneys back into the recipients.

The surgeons share that one patient was found to have developed acute humoral rejection post surgery and was correctly treated. With supposedly no long-term problems in the transplanted kidneys, four of the patients were observed to be alive at the last follow-up that ranged from nine to 41 months. A year after the transplant, the fifth recipient was known to have died from an unrelated accident. Interestingly, none of the donors or recipients seemed to exhibit the recurrence of tumors.

Patients included in the study were between 47 to 61 years of age and had an average age of 54. With an average age of 38, the donors ranged from 38 to 72. Apparently three of the five donor pairs were genetically related and two were unrelated. Together with significant other illnesses like severe high blood pressure and complex heart problems, all patients had end-stage renal disease.

“The global increase in patients with end-stage renal disease highlights the importance of identifying novel means to increase the donor pool.” says Dr Phelan.“Although donor transplants using organs from deceased people have risen 16 per cent and living donor transplants have risen by 68 per cent, there continues to be a significant shortage and many patients die each year while waiting for a transplant.”

“The current study provides evidence to suggest that kidneys from donors with renal masses offer a minor, yet feasible, solution to the current organ shortage. These organs can be transplanted into recipients with limited life-expectancy on haemodialysis after careful removal of the renal mass. However, diligent follow-up of the donor and recipient is imperative in these cases,” he further added.

After the discovery of the renal masses in the donor kidney and prior to the transplant, each recipient and donor was involved in detailed discussions. This was carried out to make both aware of the risks, including recurrence of the tumour.

The results are published in the December issue of the urology journal BJUI.