Abstract: TH-PO1044
Metachronous, Histologically Distinct Renal Cell Carcinomas in a Transplant Candidate
Session Information
- Transplantation: Clinical - Outcomes, Malignancy, and Pathology
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Frost, Livia Ann, Baylor College of Medicine, Houston, Texas, United States
- Jimenez, Yajaira Sofia, Baylor College of Medicine, Houston, Texas, United States
- Aggarwal, Nidhi, Baylor College of Medicine, Houston, Texas, United States
Introduction
Kidney transplant recipients have a 10- to 15-fold increased risk of renal cell carcinoma (RCC). This elevated risk is driven by chronic immunosuppression and underlying native kidney disease.
Case Description
A woman with ESKD secondary to lupus nephritis (class V) underwent a deceased donor kidney transplant, with immunosuppression regimen of cyclosporine and mycophenolate. Ten years later, a hypertensive emergency caused an irreversible AKI leading to allograft failure, requiring dialysis. She was re-listed for transplant and immunosuppression was weaned off.
A few years later, she presented with acute abdominal pain, fever and hematuria. An emergent non-contrast CT revealed a large hematoma surrounding an enlarged, cystic transplanted kidney (8.4 x 10.3 x 14.6 cm). A follow-up MRI incidentally identified a separate, small (1.6 cm) solid enhancing mass in the superior pole of her right solitary native kidney. Given the acute, symptomatic hemorrhage, surgical priority was given to a high-risk transplant nephrectomy. Unexpectedly, final pathology demonstrated multifocal RCC (Acquired Cystic Disease-associated and Clear Cell Tubulopapillary types) within the failed allograft.
Following recovery, the incidental native kidney mass was incorporated into a structured pre-retransplant surveillance protocol. Although it remained stable on serial imaging, she underwent a laparoscopic radical nephrectomy to rule out malignancy prior to listing. Final pathology revealed a pT1a Eosinophilic Solid and Cystic RCC and a separate cystic Clear-Cell Papillary tumor, with negative surgical margins. The patient remains on dialysis, active on the transplant waitlist, and has had no evidence of recurrence of cancer for several years.
Discussion
This case illustrates critical challenges in transplant oncology. Spontaneous hemorrhage in a cystic failed allograft can signal occult RCC, necessitating nephrectomy despite surgical risk. Furthermore, incidental renal findings on cross-sectional imaging require vigilant surveillance, as demonstrated by the diagnosis of a metachronous, histologically distinct RCC in the native kidney. Successful management of bilateral RCC through staged resection can prevent future metastatic lesions and preserve transplant eligibility.