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| Small renal masses in kidney transplantation: Overview of clinical impact and management in donors and recipients |
Alberto Pianaa,b,*( ),Iulia Andrasc,Pietro Dianaa,Paolo Verria,b,Andrea Galliolia,Riccardo Campid,e,Thomas Prudhommef,Vital Heviag,Romain Boissierh,Alberto Bredaa,Angelo Territoa,on behalf of European Association of Urology (EAU) Young Academic Urologists (YAU) Kidney Transplantation Working Group, Arnhem, Netherlands
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aDepartment of Urology, Fundació Puigvert, Autonoma University of Barcelona, Spain
bDepartment of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
cUrology Department, Iuliu Hatieganu University of Medicine and Pharmacy and Municipal Hospital, Cluj-Napoca, Romania
dUnit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
eDepartment of Experimental and Clinical Medicine, University of Florence, Florence, Italy
fDepartment of Urology and Kidney Transplantation, Toulouse University Hospital, Toulouse, France
gHospital Universitario Ramon y Cajal. Alcala University, Instituto Ramon y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
hAix-Marseille université, service de chirurgie urologique et de transplantation rénale, CHU Conception, AP-HM, Marseille, France |
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Abstract Kidney transplantation is the best replacement treatment for the end-stage renal disease. Currently, the imbalance between the number of patients on a transplant list and the number of organs available constitutes the crucial limitation of this approach. To expand the pool of organs amenable for transplantation, kidneys coming from older patients have been employed; however, the combination of these organs in conjunction with the chronic use of immunosuppressive therapy increases the risk of incidence of graft small renal tumors. This narrative review aims to provide the state of the art on the clinical impact and management of incidentally diagnosed small renal tumors in either donors or recipients. According to the most updated evidence, the use of grafts with a small renal mass, after bench table tumor excision, may be considered a safe option for high-risk patients in hemodialysis. On the other hand, an early small renal mass finding on periodic ultrasound-evaluation in the graft should allow to perform a conservative treatment in order to preserve renal function. Finally, in case of a renal tumor in native kidney, a radical nephrectomy is usually recommended.
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Received: 08 December 2021
Available online: 20 July 2022
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Corresponding Authors:
Alberto Piana
E-mail: alb.piana@gmail.com
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Flowchart of literature search.
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