title: Kidneys from patients with small renal tumours: a novel source of kidneys for transplantation.
abstract: OBJECTIVE
  To report the use of a novel donor source as a further option to increase the number of patients who might be able to receive a renal transplant.
  
  
  METHODS
  Between May 1996 and July 2007, 43 kidneys were transplanted using kidneys obtained from patients with small (<3 cm diameter) incidentally detected tumours. After bench surgery to excise the tumour, they were all successfully transplanted into patients who were elderly or had significant comorbidities.
  
  
  RESULTS
  Apart from four patients who died from unrelated illnesses, all grafts continued to function with a median and mean follow-up of 25 and 32 months. The follow-up, which included 3-monthly renal ultrasonography and chest X-rays, showed only one case of tumour recurrence, which occurred 9 years after transplantation; the patient remains stable under observation after 18 months.
  
  
  CONCLUSIONS
  From our experience we consider that where nephrectomy is used for small, localized, incidentally detected renal tumours, the kidney should be considered for transplantation into carefully selected patients. Such patients with numerous medical comorbidities might benefit from renal transplantation, but not survive the waiting period if they are dependent on a deceased donor graft. Paradoxically the use of these marginal kidneys has the potential to increase the quality and length of life of these patients, despite the apparent contradiction of an intuitive principle of organ transplantation and immunosuppression.
authors.affiliation: Renal Transplant Unit and Southern Clinical School, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia. d.Nicol@uq.edu.au
authors.forename: David L
authors.initials: DL
authors.lastname: Nicol
authors.forename: John M
authors.initials: JM
authors.lastname: Preston
authors.forename: Daryl R
authors.initials: DR
authors.lastname: Wall
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Griffin
authors.forename: Scott B
authors.initials: SB
authors.lastname: Campbell
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Isbel
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
mesh_terms: D000368:Aged; D002102:Cadaver; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery; D006801:Humans; D033162:Incidental Findings; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods* / Q000592:standards; D019520:Living Donors; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D011446:Prospective Studies; D009927:Tissue and Organ Procurement / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome