Abstract: TH-PO1051
Metastatic Epithelioid Angiosarcoma Presenting After Arteriovenous Fistula Complications in a Kidney Transplant Recipient
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
- Aggarwal, Kanika, Temple University Hospital, Philadelphia, Pennsylvania, United States
- Cheng, Derek, Temple University Hospital, Philadelphia, Pennsylvania, United States
- Graydon, Drew N., Temple University Hospital, Philadelphia, Pennsylvania, United States
- Koul, Sheetal, Temple University Hospital, Philadelphia, Pennsylvania, United States
Introduction
Angiosarcoma arising from arteriovenous fistula (AVF) is a rare but highly aggressive malignancy described in patients with ESRD after kidney transplant (KT). Most reported cases occur several years after KT. We present a case of metastatic epithelioid angiosarcoma arising from a complex AVF within a year of KT, raising concern for a pre-existing occult lesion.
Case Description
A 68-year-old woman presented with a two-month history of worsening ulcerated lesion over an aneurysmal segment of her AVF. She had received a deceased donor KT ~10 months prior. She was maintained on tacrolimus, mycophenolate, and prednisone. Her dialysis access history included thrombosis of a brachiobasilic AVF treated with angioplasty and stenting; aneurysmal degeneration, requiring revision; and recurrent aneurysm rupture, necessitating multiple interventions, including suture plication, aneurysmorrhaphy, and PTFE interposition graft placement. Her course was further complicated by graft infection, requiring explantation and conversion to a brachioaxillary graft.
Given progressive ulceration over the AVF, she underwent surgical resection of the AVF and the interposition graft. Histopathology showed high-grade epithelioid angiosarcoma.
She subsequently developed progressive dyspnea. Imaging revealed a large right pleural effusion, bilateral pulmonary nodules, and a right anterior costophrenic mass, concerning for metastatic disease. Pleural fluid analysis revealed an exudative effusion; however, cytology and CT-guided biopsy were nondiagnostic. She was scheduled for video-assisted thoracoscopic surgery, but the course was complicated by hemothorax. She had clinical deterioration and was transitioned to comfort-care.
Discussion
This case highlights a rare and rapidly progressive epithelioid angiosarcoma arising in a complex dialysis access shortly after KT. The unusually short interval between KT and diagnosis raises the possibility that malignant transformation may have preceded KT and subsequently progressed in setting of post-transplant immunosuppression, although de novo post-transplant disease cannot be excluded. This case underscores the importance of pre-transplant evaluation of longstanding or repeatedly revised dialysis access. Early recognition and tissue diagnosis of suspicious access lesions are critical, as angiosarcoma carries a poor prognosis and is frequently metastatic at presentation.