Urothelial carcinoma of donor origin in a kidney transplant patient

J Immunother Cancer. 2016 Oct 18:4:63. doi: 10.1186/s40425-016-0167-4. eCollection 2016.

Abstract

Background: Malignancy after transplantation is an uncommon multifactorial occurrence. Immunosuppression to prevent graft rejection is described as a major risk factor in malignancy development in the post-transplant state. Donor-derived malignancy is a rare reported complication. Herein, we review our patient history and discuss diagnostic strategies and the implications of immunosuppression for donor-derived malignancy.

Case presentation: This is a 69-year-old man with post-renal-transplant urothelial carcinoma determined to be of donor origin. His course was complicated by BK virus at six years post-transplant; urothelial carcinoma was identified nine years post-transplant. Cystectomy was performed, but because of immunosuppression and underlying chronic kidney disease, the patient was considered ineligible for adjuvant chemotherapy. Two years after resection, screening MRI demonstrated retroperitoneal lymphadenopathy and a right upper pole mass in the transplanted kidney. Urine cytology confirmed the presence of malignant cells; FISH showed 2-8 copies of the X chromosome and no Y chromosome consistent with female origin of the malignant cells. CT-guided renal mass and paraaortic lymph node biopsies demonstrated that about 50 % of cells had an XY complement, while the remainder showed a XX genotype by chromosomal SNP microarray analysis. Immunosuppression was discontinued and the donor kidney removed. X/Y FISH of the urothelial carcinoma identified in the explanted kidney confirmed that the malignant cells were of female donor origin. Follow-up at 3, 6 and 12 months after discontinuation of immunosuppression and surgery demonstrated normalization of the lymphadenopathy and absence of new lesions.

Conclusions: Immunosuppression is a major risk factor for development of malignancy in transplant recipients. Donor-derived malignancy can arise and current molecular studies allow an accurate diagnosis. Withdrawal of immunosuppression and surgical resection of the transplant kidney proved an effective treatment in our case.

Keywords: Immunosuppression; Post-transplant malignancy; Solid organ transplantation; Urothelial carcinoma.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • BK Virus
  • Chromosome Aberrations
  • Humans
  • Immunosuppression Therapy
  • Immunosuppressive Agents / adverse effects
  • In Situ Hybridization, Fluorescence
  • Kidney Transplantation / adverse effects*
  • Magnetic Resonance Imaging
  • Male
  • Polyomavirus Infections / complications
  • Polyomavirus Infections / virology
  • Tissue Donors*
  • Tomography, X-Ray Computed
  • Transplantation, Homologous
  • Tumor Virus Infections / complications
  • Tumor Virus Infections / virology
  • Urologic Neoplasms / diagnosis*
  • Urologic Neoplasms / etiology*
  • Urologic Neoplasms / genetics
  • Urologic Neoplasms / therapy

Substances

  • Immunosuppressive Agents