To the Editor:
We performed eight renal transplants between April 5, 1993 and February 21, 2003 from donors with distal papillary and nonpapillary transitional cell carcinomas (TCC) whose pathologic staging ranged from pTa to pT3. Kidney donation was discussed and consented after the patient decided total nephrectomy. The recipients were fully notified of its recurrence risk. This had been reported in 2008 (1). We would like to provide 3-year more updated report to address the issue of risk of donor transmitted malignancies as presented in AJT June 2011 article (2).
Of these eight patients, three died—two of causes un-related to the TCC. The third patient had recurrence of TCC in the transplanted kidney 15 months after transplant. Although graft nephrectomy was recommended, the patient adamantly refused to remain off of dialysis. Instead, the cancerous area of the urinary tract was excised and reconstructed with an ileal replacement. He eventually went on to die from presumed primary lung cancer with liver metastasis 3 years after his second operative procedure, although this could not be confirmed as no autopsy was performed. As of July 2011, four patients are alive with functioning grafts. The fifth patient is also alive but returned to dialysis.
From this small cohort, we observed a 12.5% recurrence rate. Graft survival rates at 1, 3, 5 and 10 years are 100%, 100%, 50% and 50%, patient survival rate at 1, 3, 5 and 10 years were 100%, 100%, 75% and 60%. Although a 12.5% recurrence rate would place grafts with ureteral TCC in the high-risk category for transmission according to the June 2011 AJT article (2), we would like to point out that the single recurrence noted in this group did occur in a recipient whose donor had pT3 TCC whereas the remainder of the donors had a TCC with a pT2 stage or less. This would suggest that utilizing grafts from donors with T2 or less TCC may be reasonable. In such cases, it may be reasonable to utilize fresh frozen sectioning during the back-table procedure to help determine which grafts have early stage TCC.
In conclusion, we offer that utilization of grafts from donors with TCC may be reasonable when there are limited resources, the recipient has undergone a thorough and fully informed consent, and efforts have been made to determine those grafts with early stage TCC.