Piana Alberto, Andras Iulia, Diana Pietro, Verri Paolo, Gallioli Andrea, Campi Riccardo, Prudhomme Thomas, Hevia Vital, Boissier Romain, Breda Alberto, Territo Angelo
Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Spain.
Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.
Asian J Urol. 2022 Jul;9(3):208-214. doi: 10.1016/j.ajur.2022.06.001. Epub 2022 Jun 10.
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.
肾移植是终末期肾病的最佳替代治疗方法。目前，移植等待名单上的患者数量与可用器官数量之间的失衡是这种治疗方法的关键限制因素。为了扩大适合移植的器官库，已采用来自老年患者的肾脏；然而，这些器官与长期使用免疫抑制疗法相结合，增加了移植肾小肿瘤的发病风险。本叙述性综述旨在介绍供体或受体中偶然诊断出的小肾肿瘤的临床影响及管理的最新情况。根据最新证据，在手术台上切除肿瘤后，使用有小肾肿块的移植物对于高危血液透析患者可能是一种安全选择。另一方面，在移植肾的定期超声评估中早期发现小肾肿块应允许进行保守治疗以保留肾功能。最后，对于原位肾肿瘤，通常建议行根治性肾切除术。
