Transplanted kidney loss during colorectal cancer chemotherapy: A case report

doi:10.12998/wjcc.v10.i19.6647

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Jul 6, 2022; 10(19): 6647-6655
Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6647

Transplanted kidney loss during colorectal cancer chemotherapy: A case report

Marta Pośpiech, Aureliusz Kolonko, Teresa Nieszporek, Sylwia Kozak, Anna Kozaczka, Henryk Karkoszka, Mateusz Winder, Jerzy Chudek

Marta Pośpiech, Sylwia Kozak, Jerzy Chudek, Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia in Katowice, Katowice 40-027, Poland

Aureliusz Kolonko, Henryk Karkoszka, Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice 40-027, Poland

Teresa Nieszporek, Department of Nephrology, Transplantation and Internal Medicine, Mielecki Clinical Hospital of the Medical University of Silesia, Katowice 40-027, Poland

Anna Kozaczka, Department of Internal Diseases and Oncological Chemotherapy, Mielecki Clinical Hospital, Katowice 40-027, Poland

Mateusz Winder, Department of Radiology and Nuclear Medicine, Medical University of Silesia in Katowice, Katowice 40-752, Poland

Author contributions: Kozaczka A, Chudek J and Nieszporek T collected the clinical data; Pośpiech M and Kozak S designed the case report, reviewed the literature and drafted the manuscript; Karkoszka H performed and interpreted the kidney histology; Winder M prepared and interpreted the imaging; Chudek J and Kolonko A critically reviewed the manuscript; All authors read and approved the final manuscript.

Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.

Conflict-of-interest statement: The authors declare no conflict of interest.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Sylwia Kozak, Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia in Katowice, Reymonta 8, Katowice 40-027, Poland. sylwiakozak@icloud.com

Received: December 14, 2021
Peer-review started: December 14, 2021
First decision: February 14, 2022
Revised: March 2, 2022
Accepted: April 22, 2022
Article in press: April 22, 2022
Published online: July 6, 2022
Processing time: 191 Days and 13.2 Hours

Abstract

BACKGROUND

The overall risk of de novo malignancies in kidney transplant recipients (KTRs) is higher than that in the general population. It is associated with long-lasting exposure to immunosuppressive agents and impaired oncological vigilance due to chronic kidney disease. Colorectal cancer (CRC), frequently diagnosed in an advanced stage, is one of the most common malignancies in this cohort and is associated with poor prognosis. Still, because of the scarcity of data concerning adjuvant chemotherapy in this group, there are no clear guidelines for the specific management of the CRCs in KTRs. We present a patient who lost her transplanted kidney shortly after initiation of adjuvant chemotherapy for colon cancer.

CASE SUMMARY

A 36-year-old woman with a medical history of kidney transplantation (2005) because of end-stage kidney disease, secondary to chronic glomerular nephritis, and long-term immunosuppression was diagnosed with locally advanced pT_4AN_1BM₀ (clinical stage III) colon adenocarcinoma G2. After right hemicolectomy, the patient was qualified to receive adjuvant chemotherapy that consisted of oxaliplatin, leucovorin and 5-fluorouracil (FOLFOX-4). The deterioration of kidney graft function after two cycles caused chemotherapy cessation and initiation of hemodialysis therapy after a few months. Shortly after that, the patient started palliative chemotherapy because of cancer recurrence with intraperitoneal spread.

CONCLUSION

Initiation of adjuvant chemotherapy for colon cancer increases the risk of rapid kidney graft loss driven also by under-immunosuppression.

Keywords: Kidney transplantation; Colorectal cancer; Adjuvant chemotherapy; Graft loss; Complications; Case report

Core tip: The occurrence of colorectal cancer (CRC) in kidney transplant recipients is higher than that in the general population. Advanced stage CRC is usually associated with poor outcome. Adjuvant chemotherapy may accelerate the graft loss after kidney transplant.