Elsevier

Transplantation Proceedings

Volume 51, Issue 6, July–August 2019, Pages 1773-1778
Transplantation Proceedings

Advances in Transplantation
Kidney transplantation
Outcome of Live-Donor Renal Transplants With Incidentally Diagnosed Renal Angiomyolipoma in the Donor

https://doi.org/10.1016/j.transproceed.2019.02.035Get rights and content

Abstract

Introduction

Accepting donors with renal lesion amenable for pre-transplant management with no suspected long-term harm seems to expand the live-donor pool. We aimed to assess the long-term outcome of live-donor renal transplantation with incidentally discovered renal angiomyolipoma (AML) during routine evaluation of donors.

Patients and Methods

A retrospective evaluation of incidentally discovered AML, during live-related-donor evaluation, was performed. The tumor criteria were retrieved. In cases with exophytic tumor, a back-table, partial nephrectomy was done with frozen section to exclude malignancy. Endophytic lesions were kept in situ and transplanted. Both donor and recipient were followed up by periodic imaging.

Results

Among 2925 cases, 6 AML with a median volume of 0.96 (range, 0.5–2) cm2 were identified. The median recipients' age was 21 (range, 10–38) years and the median donors' age was 48 (range, 45–50). Two AML were exophytic and back-table partial nephrectomy was performed, while 4 were endophytic and kept in situ, and the kidney was transplanted. After a median follow-up of 82 (range, 25–150) months, 4 patients were alive with functioning grafts and 2 resumed hemodialysis 5 and 7 years after transplantation. There was no evidence of increase in the AML size or newly developed AML in the grafts. All donors were alive with normal renal function (mean ± standard deviation, serum creatinine was 0.9 ± 0.2 mg/dL) and none developed new AML in the remaining kidney.

Conclusion

Incidentally discovered AML during live-donor evaluation is not a contraindication of donation after proper counseling of the couples and regular, periodic follow-up.

Section snippets

Patients and Methods

After obtaining approval from the local institutional research board (MFM/IRB no: R.18.07.245), the dedicated electronic database of live-donor renal transplant cases were retrospectively reviewed. Patients who received kidneys with incidentally diagnosed AML at preoperative evaluation, whether the tumor was excised on back-table or left in situ and transplanted, were eligible for analysis.

As a routine, all potential donors were fully evaluated by a team including a nephrologist, a urologist,

Results

The study included 6 live, related-donor renal transplants with a median age of 21 (range, 10–38) years. The donors were healthy individuals with no comorbidities with a median age of 48 (range, 45–50) years at the time of donation. The causes of ESRD were unknown in 1, glomerulonephritis in 1, hypertensive nephropathy in 1, posterior urethral valve in 1, and vesicoureteral reflux in 2 patients. Table 1 illustrates patients' demographics.

In 2 cases, where the tumor was exophytic, ex vivo

Discussion

The reported prevalence of ESRD in Egypt was 375 patients per million people with a yearly incidence of 74 patients per million people [7]. Hemodialysis is the predominant form of renal replacement therapy. This may be attributed to the shortage of available live donors and the absence of a national deceased-donor program. Consequently, this increases the economic burden on both the health care system and diseased individuals. Thus, the need to expand the base of live donation is a necessary

Conclusion

Presence of incidentally discovered renal AML should not prohibit donation. Tumor excision (if exophytic) or keeping in situ (if small endophytic) and completing the procedure of transplantation is not associated with an increased risk of long-term complications or unfavorable graft function outcome. It might expand the criteria for accepting marginal donors in an attempt to overcome the problem of organ shortage.

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