Abstract: SA-PO1033
Delayed Presentation of Donor-Derived Allograft Squamous-Cell Carcinoma in a Kidney Transplant Recipient
Session Information
- Transplantation: Clinical - 4
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Pagan, Ricardo Alberto, Northwell Health, New Hyde Park, New York, United States
- Bhaskaran, Madhu C., Northwell Health, New Hyde Park, New York, United States
Introduction
We present an unusual case of allograft squamous cell carcinoma (SCC) in a kidney transplant recipient, presenting as a mass in the allograft. While kidney transplants notably enhance life expectancy and quality of life, there is a risk of malignancies. Despite SCC of the skin being one of the most common malignancies in transplant recipients it is an rare neoplasm in the allograft.
Case Description
58 years old male, with history of end stage renal disease related to diabetes, received deceased donor renal transplant. Other comorbidities included hypertension and nephrolithiasis. Post-transplant course included CMV viremia, managed with Valganciclovir. He had a kidney biopsy when due to presentation of persistent generalized weakness, oliguria, elevated creatinine and dark urine. An ultrasound revealed a focal mass lesion of allograft kidney which was followed by a MRI showing a 4.9 cm mass in the transplanted kidney. Biopsy revealed SCC and due to declining GFR and oliguria, patient required hemodialysis. Nephrectomy was performed, immunosuppression discontinued and the patient remains on hemodialysis with oncology follow-up. Interestingly the recipient of the other kidney from the same donor was tracked and was found to be undergoing treatment for metastatic squamous cell carcinoma.
Discussion
Among post-transplant malignancies, SCC of the renal allograft stands out as a rare case. Chronic inflammation and irritation play a crucial role in the development of primary SCC, with the urothelium potentially converting to squamous cells due to irritants like kidney stones and recurrent infections. Additionally, oncogenic viruses like Epstein Barr Virus (EBV) and CMV may contribute to oncogenesis. Immunosuppression is well known to predispose to malignancies. Renal cell carcinoma and papillomas are reported in transplanted kidneys, with donor age, especially over 45, being a significant risk factor for cancer transmission. Even though donor derived malignancies are a known risk in solid organ transplant there are reports of successful outcomes of kidney transplantation with well circumscribed small tumor after they are resected.
The atypical presentation of SCC in renal allograft raises questions about donor screening methods prior to organ allocation and reminds the need to keep donor derived malignancies in mind on delayed post-transplant period.