Last Resort for Renal Transplant Recipients, ‘Restored Kidneys’ from Living Donors/Patients

Abstract

Because of the grave shortage of deceased kidney allografts in Japan, we have embarked on a new source of organs, 'Restored kidneys' from living patients. From January 1991 through September 2006, 42 kidneys (eight benign pathology, eight small renal cancers, eight ureteral cancers, six aneurysms, eight severe nephrotic syndrome from four patients and four ureteral stenosis) were obtained from 38 patients/donors after extensive discussion of treatment modalities and risks. All patients/donors agreed to undergo total nephrectomy. The lesions were removed/repaired ex vivo on the back table, then transplanted. All recipients were notified of all possible risks including donor disease recurrence. One, 5 and 10-year patient survival rates of restored transplant patients were 92.9%, 79.3% and 63.8%, respectively. One, 5 and 10-year graft survival rates of restored kidney transplant patients were 78.6%, 51.8% and 42.7%, respectively. There were no recurrences of small renal cell carcinomas. There was one recurrence of ureteral cancer in the transplanted kidney 15 months after operation.In countries where deceased donors are scarce, such as Japan, the restored kidneys can be a last resort for renal allografts.

The Impact of Donor Type and Quality on Renal Transplant Outcomes

“…There was one tumour recurrence occurring at 9 years post-transplantation, but it was unclear whether this was donor-derived. An additional 22 similar successful cases from United States and Japan were reported with no documented tumour recurrence (Buell J 2005;Mannami, Mannami et al 2008). …”

Infection and Cancer Screening in Potential Living Donors: Best Practices to Protect the Donor and Recipient

“…However, there have been reports of living donor renal transplants from patients with <3 cm RCC that were excised on the back table with subsequent successful transplant. In one study, out of 43 transplants performed (5 DD and 38 LD), there was only one recurrence of RCC within a transplanted kidney 9 years after the original operation [2,3]. Another group reported their living donor transplant experience from eight donors with resected RCC and eight donors with resected low-grade ureteral cancer; the group reported no recurrences of RCC and a single recurrence of ureteral cancer 15 months after the transplant [3,4].…”

Gender Bias in Living Donor Kidney Transplantation in Japan: a Questionnaire Survey in Spousal Renal Donors

“…Many of these nephrectomized kidneys could be successfully transplanted after surgical restoration with satisfactory results [10]. However, the issue of cancer recurrence is a concern in surgically restored cancerous kidney transplantation.…”