title: Transplantation of Restored Kidneys From Unrelated Donors After Resection of Renal Cell Carcinoma: Results From 10 Patients.
abstract: OBJECTIVE
  To relieve the chronic shortage of donor kidneys, we conducted a prospective kidney transplantation trial using kidneys removed from 10 unrelated patients (51 to 79 years of age) who had undergone nephrectomy for small renal cell carcinoma (1.5 to 3.9 cm) of low-to-moderate complexity based on RENAL (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior/posterior location relative to polar lines) nephrometry (objective description helpful for operative indication and planning).
  
  
  METHODS
  Donors were selected from among 15 patients who opted to undergo nephrectomy for small renal cell carcinoma. A total of 76 dialysis patients 34 to 85 years of age who agreed to undergo restored kidney transplantation were recruited as transplant candidates.
  
  
  RESULTS
  In stage 1 (5 cases), high-risk patients were selected without human leukocyte antigen testing, and accelerated acute rejection occurred in 4 of 5 recipients. This trial was subsequently extended with human leukocyte antigen testing, and an additional 5 patients were enrolled in stage 2. Eight recipients, including 4 recipients with a history of renal transplantation, experienced rejection; 1 patient resumed dialysis 35 months after transplantation. The most recent serum creatinine levels ranged from 1.10 to 3.19 mg/dL in the 9 recipients with functioning grafts and from 0.84 to 4.68 mg/dL in the 10 donors. No tumor recurrence was noted at 32 to 58 months after surgery in either the recipients or the donors.
  
  
  CONCLUSIONS
  Restored kidney transplantation using kidneys with a small renal tumor seems suitable for carefully selected high-risk recipients and, in particular, elderly kidneys can also function well. Avoiding cancer transmission, fair recipient selection, close follow-up, and a well-organized tracking system warrant further study.
authors: Department of Urology, Tokyo-West Tokushukai Hospital, Akishima-city, Tokyo-to, Japan. Electronic address: yoshihide.ogawa@tokushukai.jp.
authors: Y
authors: Y
authors: Ogawa
authors: Department of Urology, Uwajima Tokushukai Hospital, Uwajima-city, Japan.
authors: K
authors: K
authors: Kojima
authors: Department of Urology, Uwajima Tokushukai Hospital, Uwajima-city, Japan.
authors: R
authors: R
authors: Mannami
authors: Department of Urology, Uwajima Tokushukai Hospital, Uwajima-city, Japan.
authors: M
authors: M
authors: Mannami
authors: Department of Urology, Kagoshima Tokushukai Hospital, Kagoshima-city, Japan.
authors: K
authors: K
authors: Kitajima
authors: Department of Urology, Saint Martin's Hospital, Sakaide-city, Japan.
authors: M
authors: M
authors: Nishi
authors: Department of Urology, Kure-Kyosai Hospital, Kure-city, Japan.
authors: S
authors: S
authors: Ito
authors: Department of Urology, Kure-Kyosai Hospital, Kure-city, Japan.
authors: N
authors: N
authors: Mitsuhata
authors: Department of Urology, Okinawa Chubu Tokushukai Hospital, Okinawa-city, Japan.
authors: H
authors: H
authors: Afuso
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000601:surgery*; D007680:Kidney Neoplasms / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D061349:Unrelated Donors