Use and outcomes of kidneys from donors with renal angiomyolipoma: A systematic review
Desiree Garcia Anton1, Karthik Kovvuru1, Swetha R Kanduri1, Narothama Reddy Aeddula2, Tarun Bathini3, Charat Thongprayoon4, Wisit Kaewput5, Karn Wijarnpreecha6, Kanramon Watthanasuntorn7, Sohail Abdul Salim1, Praise Matemavi8, Pradeep Vaitla1, Franco Cabeza Rivera1, Wisit Cheungpasitporn1
1 Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
2 Department of Medicine, Division of Nephrology, Deaconess Health System, Evansville, IN, USA
3 Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
4 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
5 Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
6 Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, Florida, USA
7 Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York, USA
8 Department of Transplant and Hepatobiliary Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi 39216
Background: 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.
Methods: 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).
Results: 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 ex vivo resection (65%) before transplantation, followed by no resection (18%), and the remaining had in vivo 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.
Conclusion: 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.