Anton Desiree Garcia, Kovvuru Karthik, Kanduri Swetha R, Aeddula Narothama Reddy, Bathini Tarun, Thongprayoon Charat, Kaewput Wisit, Wijarnpreecha Karn, Watthanasuntorn Kanramon, Salim Sohail Abdul, Matemavi Praise, Vaitla Pradeep, Rivera Franco Cabeza, Cheungpasitporn Wisit
Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Department of Medicine, Division of Nephrology, Deaconess Health System, Evansville, IN, USA.
Urol Ann. 2021 Jan-Mar;13(1):67-72. doi: 10.4103/UA.UA_14_20. Epub 2021 Jan 19.
Renal angiomyolipoma (AML) is the most frequent mesenchymal tumor of the kidney. Although there is a rare possibility of malignant transformation of AML, this risk has not been studied in immunosuppressed patients. The safety of donors with AML and their kidney transplant recipients has not been well established.
A literature search was conducted utilizing MEDLINE, EMBASE, and Cochrane databases from inception through May 15, 2018 (updated on October 2019). We included studies that reported the outcomes of kidney donors with AML or recipients of donor with AML. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42018095157).
Fourteen studies with a total of 16 donors with AML were identified. None of the donors had a diagnosis of tuberous sclerosis complex (TSC), pulmonary lymphangioleiomyomatosis (LAM), or epithelioid variant of AML. Donor age ranged from 35 to 77 years, and recipient age ranged from 27 to 62 years. Ninety-two percent of the donors were female. Only 8% were deceased donor renal transplant. The majority underwent resection (65%) before transplantation, followed by no resection (18%), and the remaining had resection. Tumor size varied from 0.4 cm to 7 cm, and the majority (87%) were localized in the right kidney. Follow-up time ranged from 1 to 107 months. Donor creatinine prenephrectomy ranged 0.89-1.1 mg/dL and postnephrectomy creatinine 1.0-1.17 mg/dL. In those who did not have resection of the AML, tumor size remained stable. None of the donors with AML had end-stage renal disease or died at last follow-up. None of the recipients had malignant transformation of AML.
These findings are reassuring for the safety of donors with AML (without TSC or LAM) as well as their recipients without evidence of malignant transformation of AML. As such, this can also positively impact the donor pool by increasing the number of available kidneys.
肾血管平滑肌脂肪瘤（AML）是最常见的肾脏间叶性肿瘤。虽然AML存在罕见的恶变可能性，但尚未在免疫抑制患者中研究过这种风险。患有AML的供体及其肾移植受者的安全性尚未得到充分证实。
利用MEDLINE、EMBASE和Cochrane数据库进行文献检索，检索时间从建库至2018年5月15日（2019年10月更新）。我们纳入了报告患有AML的肾脏供体或接受患有AML供体肾脏移植受者结局的研究。该荟萃分析方案已在PROSPERO（国际系统评价前瞻性注册库；编号CRD42018095157）注册。
共确定了14项研究，涉及16名患有AML的供体。所有供体均未诊断为结节性硬化症（TSC）、肺淋巴管平滑肌瘤病（LAM）或AML上皮样变型。供体年龄范围为35至77岁，受者年龄范围为27至62岁。92%的供体为女性。仅8%为 deceased donor肾移植。大多数供体在移植前接受了切除（65%），其次是未切除（18%），其余进行了切除。肿瘤大小从0.4 cm至7 cm不等，大多数（87%）位于右肾。随访时间为1至107个月。供体术前肌酐范围为0.89 - 1.1 mg/dL，术后肌酐为1.0 - 1.17 mg/dL。在未切除AML的患者中，肿瘤大小保持稳定。在最后随访时，没有AML供体发生终末期肾病或死亡。没有受者发生AML恶变。
这些发现对于患有AML（无TSC或LAM）的供体及其未出现AML恶变证据的受者的安全性是令人安心的。因此，这也可以通过增加可用肾脏数量对供体库产生积极影响。
