Conference Proceeding

Case report: Renal Cell Carcinoma of first Kidney Allograft in transplanted recipient for second time

Dr. Hind Hassan Al Nour,
Dubai Health Authority, Dubai

Introduction: After kidney transplantation, the use of immunosuppression therapy for the preservation of kidney function increase the incidence of malignancies in transplant recipients compared with that of the general population. The diagnosis tumors in renal allograft are usually accidental following ultrasonography, CT scan or MRI imaging, so special attention is important during any imaging examination of renal allograft to detect tumors as early as possible. In patients with the renal transplant; malignancies of the urinary tract is the second most common following skin tumor. The most affected organs prostate, kidneys, bladder and testes.
Case report: 51 years old male who had his first kidney transplantation in 1987 on the right side from living unrelated donor, he had approached ESRD in 2006 and underwent his second renal transplantation in June 2006 on the left side, again from living unrelated donor. Though he had stable kidney function, he started to have intermittent hematuria with bulging right lower loin. Ultrasound had revealed a big mass in the right transplanted kidney. CT scan with contrast demonstrated a large lobulated outlines heterogeneously enhancing mass arising from the iliac fossa of first transplanted kidney (measures 8.7x6.9x11.5cm in diameter) with local, lungs metastasis and right common iliac vein metastasis. Due to above finding patient underwent right allograft nephrectomy.
Conclusions: The ability to identify and prevent solid organ tumors in the transplant patient, especially early stage carcinomas depends on regular screening examinations and strict adherence to prophylactic measures. Screening of the patient and donor prior to transplantation can help to detect any underlying pre-existing malignancy. Immunologic human leukocyte antigen typing and (DNA) genetic analysis should be done on each tumor specimen to detect the recipient or donor origin of the malignancy when possible. Renal cell carcinoma is common to occur in the native kidneys after renal allograft with different incidence. Ultrasonography of grafted kidney should be done annually for life. If the tumor is small and localized; It can be treated with conservative management like radio frequency ablation or partial nephrectomy. Total transplant nephrectomy can give a durable cure but it will return the patient to chronic dialysis.

Published: 28 April 2017