Pediatric Nephrology Service, Hospital La Paz, Pº Castellana nº 161, 28045, Madrid, Spain.
Pediatr Nephrol. 2012 Dec;27(12):2319-21. doi: 10.1007/s00467-012-2255-0. Epub 2012 Jul 18.
Published data on kidneys transplanted after resecting small renal cancers during the transplantation surgery are very rare and, to the best of our knowledge, no pediatric cases have been reported in the literature.
CASE-DIAGNOSIS/TREATMENT: Our patient was diagnosed with a bilateral Wilms tumor when he was 15 months old. A total bilateral nephrectomy was required to control the disease. Two years later, a human leukocyte antigen (HLA)-identical living-donor transplant from his father was performed. A small mass in the father's left kidney was diagnosed as an angiomyolipoma during the pretransplant donor evaluation. During the surgery, the mass was excised and the kidney implanted. One week later, the pathological study revealed the mass to be a clear cell renal carcinoma. After joint discussion, the urologic and nephrologic teams and the family decided to maintain the transplant, managing the patient with monotherapy based on rapamycin and close ultrasound control. To date, 8 years after transplantation, no signs of malignancy have been detected, and renal function is normal.
This is the first reported pediatric case of a living-donor graft with a small renal carcinoma excised in the operating room. No malignancy has been observed in 8 years of follow-up.
在移植手术中切除小肾癌后进行移植的肾脏的相关数据非常罕见，据我们所知，文献中尚无儿科病例报道。
病例诊断/治疗：我们的患者在 15 个月大时被诊断为双侧 Wilms 瘤。需要进行双侧全肾切除术来控制疾病。两年后，他的父亲作为 HLA 相同的活体供者进行了同种异体移植。在供者移植前评估中，父亲左肾的一个小肿块被诊断为血管平滑肌脂肪瘤。在手术过程中，切除了肿块并植入了肾脏。一周后，病理研究显示肿块为透明细胞肾细胞癌。经过联合讨论，泌尿科、肾脏科团队和家属决定保留移植，基于雷帕霉素进行单药治疗，并进行密切的超声检查。截至目前，移植后 8 年，未发现恶性肿瘤迹象，肾功能正常。
这是首例在手术室中切除小肾癌的活体供者移植后发生的儿科病例报道。8 年的随访中未观察到恶性肿瘤。
