Complete Remission of Donor-Derived Metastatic Urothelial Carcinoma After Transplant Nephrectomy and Discontinuing Immunosuppression
- Transplantation: Clinical - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
- 2102 Transplantation: Clinical
- Dawodu, Ebenezer Adeboye, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Wall, Barry M., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Rustom, David S., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Talwar, Manish, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
De novo urothelial carcinoma is associated with kidney transplant and tends to present with advanced disease at diagnosis. We present a case of donor derived metastatic urothelial carcinoma with complete remission following transplant nephrectomy and withholding immunosuppression.
A 55-year-old male with ESRD secondary to hypertensive nephropathy was on dialysis from 1992 -2005 and underwent deceased donor kidney transplant in 2005. Dual kidney transplant was performed due to donor’s smoking history and donor finding of > 10% glomerulosclerosis. He did well post-transplant, baseline creatinine, 1.3 mg/dL. He developed allograft dysfunction with biopsy showing BK Polyoma Nephropathy in 2006. In 2021, he presented with bilateral flank pain and gross hematuria for 1 week. Urine cytology was positive for urothelial carcinoma. Bladder and prostatic urethra biopsies and right native renal pelvis washing were negative for carcinoma. Cytology from superior transplant kidney demonstrated high-grade urothelial carcinoma. PET CT in June 2021 showed abdominopelvic retroperitoneal nodal metastatic disease extending cephalad into the right retrocrural region with relative sparing of the pelvic nodal chains and focal hypermetabolism of the left adrenal gland, presumed to be metastatic. Both transplant kidneys were surgically removed in June 2021. Lymph node dissection and adrenalectomy were not performed due to position and proximity to the aorta. A 5 x 4 cm high grade urotheilial carcinoma with lymphovascular invasion was present in the pelvis of the superior allograft. BK virus DNA was undetectable in 2021. Immunosuppressive therapy included CNI, mycophenylate, and low dose prednisone. Immunosuppression was discontinued after resuming hemodialyis. Patient did not receive chemotherapy. Subsequent PET CT scans as recently as March 2023 demonstrated complete remission of metastatic disease. Cell-free DNA was < 0.12%, below the threshold for detection, supporting the absence of tumor.
We report a case of complete remission of donor derived metastatic urothelial carcinoma following transplant nephrectomy and immunosuppression withdrawal. Future research should explore the balance between innate immunity as a protective factor against malignancy and immunosuppression to prevent rejection.