Abstract: PO1859
Recurrent Renal Cell Carcinoma Post Renal Transplantation
Session Information
- Cancer and Kidney Diseases: Nephrotoxins, RCC, and More
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Rakic, Ivan, Wayne State University School of Medicine, Detroit, Michigan, United States
- Patil, Rujuta R., Wayne State University School of Medicine, Detroit, Michigan, United States
- Patel, Anita K., Henry Ford Hospital, Detroit, Michigan, United States
Introduction
Renal Cell Carcinoma (RCC) can occur in renal transplant recipients (RTR). RCC recurrence post nephrectomy occurs in 20-40% of non-transplant(Tx) patients and in less than 15% of RTR. The median survival for patients with metastasis is 6-12 months with 5 year survival less than 10%. We present 3 RTR who developed recurrent RCC post-Tx.
Case Description
RTR1 was 61 years old and received a deceased donor kidney Tx (DDKTx) for IgA nephropathy. He was induced with thymoglobulin. Immunosuppression(IS) included Mycophenolate Mofetil (MMF), Tacrolimus (FK), and steroids (S). 8 years pre-Tx, a 2.5cm RCC lesion was found in the R native kidney, and he underwent nephrectomy. 1 year later, he developed BK viremia, and IS was changed to Everolimus and S. 2 years post-Tx, RCC metastasis was detected only in the pancreas head and tail. Treatment involved tyrosine kinase inhibitors(TKI) and VEGF inhibitors without resolution; he died within 2 years of RCC recurrence with a functioning allograft.
RTR2 was 56 years old and received a DDKTx, secondary to ADPKD. IS involved MMF, Cyclosporine, and S. History was significant for L nephrectomy 3 years pre-Tx for RCC. 1 year later, she had a R nephrectomy for RCC. Both lesions were small and renally limited. 10 years post Tx, she presented with recurrent RCC in the pancreas and thyroid. Treatment involved change in IS to Sirolimus and Azathioprine. No other treatment was taken by the patient. She died 4 years later with a functioning allograft.
RTR3 is a 54 year-old who received a living, related renal Tx for CKD stage 5. IS included MMF, FK, and S. 8 years post-Tx, he was diagnosed with an 8cm RCC lesion of the L native kidney and underwent nephrectomy. After a 6 year tumor free interval, RCC recurred only in the lungs and lymph nodes. He received IS reduction and TKI with progression of disease to bone metastasis. His current treatment involves TKI with Denosumab, and he still has a functioning allograft.
Discussion
Our cases demonstrate that RCC recurrence occurs at variable time points post-Tx and can present aggressively in RTR with poor outcomes. We suspect that recurrent disease arises from micrometastatic tumor cells that escape immune surveillance. RTR with a history of RCC prior to Tx should be monitored closely for metastatic recurrence post Tx.