Purpose: In an effort to increase the overall donor pool, the use of extended-criteria kidneys has been routine in the majority of transplant centers. It is well known that benign and malignant kidney diseases also increase with age; therefore, the risk of transmission of theses pathologies with the graft is also greater. The evaluation of deceased kidney donors often includes an image test of the organs to be donated. The visual inspection of the kidney during surgery is often enough to diagnosis pathologies such as lithiasis or small/intraparenchimal tumors. We present our experience with undetected pathologies in kidney transplant from deceased donors.

Methods: A retrospective analysis of a consecutive series of 1829 renal transplantations between January 2005 and May 2014 was carried out. Of these, 1115 (60.96%) were from deceased donors and 304 were from extended criteria donors (119 older than 60 yrs and 185 between 51-59 yrs with a risk factor). We found a total of 8 grafts that had not been diagnosed with diseases that were transmitted with the kidney (6 grafts with lithiasis and 2 with malignant tumors). The incidence of these pathologies in the extended and non-extended criteria donor groups was compared. We also verified whether these pathologies led to surgical intervention, increased morbidity or death.

Results: In our study, the incidence of the overall undetected pathologies in allografts from deceased donors was 0.71%. The risk of disease transmission was much higher in the extended criteria group (1.97% vs 0.24%, p= 0.0066). Of all 8 kidneys with undetected pathologies, 4 required further treatment (2 patients with malignant tumors and 2 patients with stones). In these patients, 2 transplant nephrectomies, 1 percutaneous nephrolithotripsy and 1 extracorporeal shock wave lithotripisy were performed. In the other 4 patients with small kidney stones, conservative management was taken.

Conclusion: Post-transplant malignancy or stone disease are uncommon events, even though they represent an unfavorable prognosis and frequently lead to further invasive treatment. The increasing age of the overall donor pool may represent a risk for undetected pathologies. The routine use of imaging studies in organ donors should be considered in the extended criteria group.

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