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Kidney Week

Abstract: TH-PO572

Choriocarcinoma Related to Kidney Transplantation

Session Information

  • Trainee Case Reports - II
    October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 1802 Transplantation: Clinical

Authors

  • Santa Catharina, Guilherme P., University of Sao Paulo, Sao Paulo, Brazil
  • Onuchic, Laura, University of Sao Paulo, Sao Paulo, Brazil
  • L Leite, Ivens S., University of Sao Paulo, Sao Paulo, Brazil
  • Barsotti, Gabriel C., University of Sao Paulo, Sao Paulo, Brazil
  • Castro, Maria cristina R., University of Sao Paulo, Sao Paulo, Brazil
  • Testagrossa, Leonardo A., Hospital Sirio Libanes, São Paulo, São PAULO, Brazil
  • De paula, Flavio, University of Sao Paulo, Sao Paulo, Brazil
Introduction

Malignancy related to solid-organ transplantation (Tx) due to immunosuppression is widely discussed and appears as one of the most common causes of graft failure and death. Cancer in the donated organ is rare, however, and its prognosis uncertain.

Case Description

A 58 year-old (y/o) male, on hemodialysis for the past 5 years due to hypertensive nephrosclerosis, was admitted for kidney Tx. His serologies and Panel Reactive Antibodies were negative. The donor was a 41 y/o female whose cause of death was subarachnoid hemorrhage. Her creatinine was 0.6mg/dL and 2 previous spontaneous abortions were the only reported significant medical history. Tx proceeded with a 31-hour cold ischemia time, a 0.86 KDRI and 36% KDPI. We followed institutional protocols for surgery and immunossupression, with no apparent complications. The patient presented delayed graft function, assessed by kidney ultrasound, CT scan and biopsy. The diagnosis of acute BANFF IIB rejection was established and treatment with Thymoglobulin® initiated, however no graft function improvement was observed. He developed infectious complications thereafter, followed by transplantectomy due to the possibility of pyelonephritis. Anatomopathological analysis of the graft revealed metastatic choriocarcinoma to the kidney. Similar findings were reported in other recipients of organs from the same donor. The heart recipient presented normal graft function and no signs of metastasis despite abnormal levels of serum beta-HCG (45mUI/mL). The contralateral kidney recipient evolved with normal graft function in spite of ascending serum beta-HCG (48.450mUI/mL). Shortly after, she presented pulmonary metastasis and death after refusing transplantectomy and an unsuccessful attempt of chemotherapy. The liver transplant in another recipient was initially successful, however ascending beta-HCG and hepatic nodules were identified. This patient is currently under chemotherapy. Our patient has presented full recovery following transplantectomy, with no signs of metastasis on PET-CT scan and normal serum levels of beta-HCG (1mUI/mL).

Discussion

To our knowledge, this is the second report of kidney graft with choriocarcinoma metastasis, however the first to compare outcomes between kidney graft preservation and transplantectomy, and its metastatic implications to different grafts.