Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2021; 9(17): 4365-4372
Published online Jun 16, 2021. doi: 10.12998/wjcc.v9.i17.4365
Kidney re-transplantation after living donor graft nephrectomy due to de novo chromophobe renal cell carcinoma: A case report
Hui Wang, Wen-Li Song, Wen-Juan Cai, Gang Feng, Ying-Xin Fu
Hui Wang, Wen-Li Song, Gang Feng, Ying-Xin Fu, Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
Wen-Juan Cai, Department of Pathology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
Author contributions: Wang H summarized the clinical data and drafted the manuscript; Feng G contributed to the conception of the study and final approval of the version of the article to be published; Song WL, Feng G, and Wang H performed transplant surgery; Cai WJ contributed to acquisition and interpretation of pathological images; Fu YX contributed to the conception of the study.
Supported by National Natural Science Foundation of , No. 81970654.
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 that they have no conflict of interest to report.
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).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gang Feng, MD, PhD, Chief Doctor, Surgeon, Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fukang Road, Nankai District, Tianjin 300192, China. fengganghtc@163.com
Received: January 23, 2021
Peer-review started: January 23, 2021
First decision: February 11, 2021
Revised: February 15, 2021
Accepted: March 29, 2021
Article in press: March 29, 2021
Published online: June 16, 2021
Processing time: 123 Days and 5.4 Hours
Abstract
BACKGROUND

There are few reported cases of allograft nephrectomy due to malignancy followed by successful renal re-transplantation two years later. In this paper, we report a patient who underwent kidney re-transplantation after living donor graft nephrectomy due to de novo chromophobe renal cell carcinoma (ChRCC) involving the allograft kidney.

CASE SUMMARY

A 34-year-old man underwent living kidney transplantation at the age of 22 years for end-stage renal disease. Maintenance immunosuppression consisted of tacrolimus, mycophenolate mofetil (MMF), and prednisone. Six years post-transplantation, at another hospital, ultrasonography revealed a small mass involving the upper pole of the graft. The patient declined further examination and treatment at this point. Seven years and three months post-transplantation, the patient experienced decreasing appetite, weight loss, gross hematuria, fatigue, and oliguria. Laboratory tests showed anemia (hemoglobin level was 53 g/L). Contrast-enhanced computed tomography revealed a large heterogeneous cystic-solid mass involving the upper pole of the renal allograft. Graft nephrectomy was performed and immunosuppressants were withdrawn. Histological and immunohistochemical features of the tumor were consistent with ChRCC. One year after allograft nephrectomy, low doses of tacrolimus and MMF were administered for preventing allosensitization. Two years after allograft nephrectomy, the patient underwent kidney re-transplantation. Graft function remained stable with no ChRCC recurrence in more than 2-years of follow-up.

CONCLUSION

De novo ChRCC in kidney graft generally has a good prognosis after graft nephrectomy and withdrawal of immunosuppression. Kidney re-transplantation could be a viable treatment. A 2-year malignancy-free period may be sufficient time before re-transplantation.

Keywords: Chromophobe; Renal cell carcinoma; Kidney; Nephrectomy; Transplantation; Case report

Core Tip: Chromophobe renal cell carcinoma (ChRCC) is a rare malignancy of kidney allografts. This paper presents a case of de novo ChRCC arising primarily in an allograft kidney many years post-transplantation. It was successfully managed by allograft nephrectomy, and 2 years later, the patient underwent successful re-transplantation. Graft function was stable with no ChRCC recurrence beyond 2 years after re-transplantation. There are no guidelines for kidney re-transplantation after graft nephrectomy due to graft cancer. It remains a challenge to balance prevention of allosensitization and recurrence of cancer.