Risky donor' transplant trial

Risky donor' transplant trial
NICK MILLER
December 14, 2009

THE Royal Melbourne Hospital has begun a trial of a controversial transplant technique that uses cancerous kidneys.

''Marginal'' or ''risky donor'' transplants work on the theory that a kidney with the cancer cut out is better than none - especially for older people.

But some experts believe the risk is not worth taking.

The trial is being led by renal physician Professor Rowan Walker, who says two patients got such transplants this year, and he hopes to do ''three or four'' in 2010.

Although Brisbane's Princess Alexandra Hospital pioneered the technique in Australia more than a decade ago, the Royal Melbourne is believed to be the first to bring it to Victoria.

Other local hospitals are watching with interest - the Austin is waiting for more trial data before it decides whether to follow suit. However, another hospital has rejected the idea, saying it doesn't believe the results are acceptable.

Chronic kidney disease is on the rise - at the end of 2007 there were 9642 Australians on dialysis at an estimated cost of $1 million a week.

The number of hospitalisations for dialysis has more than doubled in the last five years, as a result of the ageing population and spread of diabetes. On average, more than 40 Australians die of kidney failure each day.

This has led to long waiting lists for donor kidneys: as of a month ago, 1283 Australians were on the list for a kidney, making up three-quarters of the entire transplant waiting list.

''We are always looking to increase the opportunities to make a kidney transplant possible,'' Professor Walker said.

He said that if a patient has a sufficiently small cancer confined to their kidney, the cancer can be cut out and the kidney given to a donor.

However, Professor Walker noted that although the procedure removes the main tumour, some traces of the disease may remain.

For this reason, he said, it is a better option for older people, because the risk of the cancer returning increases the longer it is in a patient.

''It is difficult to quantify the risk - you have to take that into account when counselling [the prospective recipient],'' he said. ''You have to say to them, 'This kidney has had a tumour … and we can't guarantee it will not come back later.' ''

Last year, the Brisbane team reviewed 43 of its ''risky donor'' transplants and found only one case of tumour recurrence, nine years after transplantation.

The Austin Hospital's Professor Frank Ierino said the technique was ''pushing the boundaries'', but that his team had been discussing whether to try it themselves.

But a renal expert at another hospital said other studies had less clear results. ''This has been around for a while but we don't do it - results haven't always been as good as this rosy report,'' they said.

http://www.theage.com.au/national/risky-donor-transplant-trial-20091213-kqi5.html