In vivo partial nephrectomy of angiomyolipoma with concurrent transplantation.

INTRODUCTION/OBJECTIVE: To describe a novel management approach to patients presenting for living renal donation who have a suspicious renal mass or cyst and review the current literature for the management of renal allografts containing masses.

MATERIALS AND METHODS: We retrospectively reviewed the preoperative, intraoperative, and postoperative records of both the donor and recipient for pertinent imaging, laboratory results, and complications. We also performed a Medline search to review the world literature of such cases, using the key words that we have listed for this article.

RESULTS: In our reported case, an angiomyolipoma (AML) was confirmed intraoperatively in the donor, the donor nephrectomy was completed, and the graft was successfully transplanted. There were no postoperative complications. The recipient remains off dialysis with a serum creatinine of 2.4 mg/dl at 18 months of follow-up. Review of the current literature supports using a similar strategy for both renal masses and suspicious cysts. Furthermore, it confirms the safety and benefits of using a laparoscopic surgical approach to similar patients in the future.

CONCLUSIONS: Intraoperative pathologic analysis of small renal lesions in a renal allograft is a feasible procedure for potential kidney donors. In the future modifying this approach with a combined laparoscopic partial and donor nephrectomy will minimize the morbidity to the donor. Applying this technique may have a positive effect on organ supply.