Case report: Ureteral carcinoma after kidney transplant (2008)

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Ready to upload
Record number: 
1911
MPHO Type: 
Estimated frequency: 
Most recent risk assessment for urothelial carcinoma (Council of Europe, 2022): No literature exists regarding newly diagnosed urothelial cancer and organ donation. Therefore, the highest caution is recommended, and the advice of a urologist may be sought in assessing the individual donor tumour transmission risk. National recommendations should be followed since they vary in accepting these tumours. Urothelial cancer in the donor history: Strict follow-up must have been provided after primary diagnosis because these tumours may be multicentric and tend to recur, with a need for repeated cystoscopy and TUR-B, and for restaging. Kidney transplantation will be associated with increased risk, but this has not been classified in the literature yet. After a disease-free interval > 5 years, the transmission risk of invasive urothelial cancer will depend on the probability of cure and must be assessed individually before accepting a potential organ donor. No specific recommendations are available from the literature.
Time to detection: 
First signs of urothelial obstruction 3 weeks after transplant. Diagnosis of urothelial cancer by transplant nephrectomy 5 months after transplant.
Alerting signals, symptoms, evidence of occurrence: 
Kidney transplant from a 70-year-old donor (20 pack-years, no known or suspected malignancy) to a 71-year-old recipient. Initially slow improvement of kidney function and subsequent rise in creatinie levels. On post-op day 36 nephrostomy catheter was placed and on day 80 placement of pigtail catheter was performed due to continuing (and now complete) proximal ureter stenosis. Additional rejection therapy led to decrease of creatinine levels. Five months after kidney transplantation (KTX) the graft was removed due to malfunction, recurrent urinary tract infection (MDR gram neg), rejection, recipient's other complication (PCP, CMV), insufficient arterial graft perfusion. In the removed graft, low-grade non-invasive papillary urothelial carcinoma was detected. Consequently, the remaining ureter of the donor and the ureterocystic anastomosis was removed. No addtional signs of malignancy was observed at follow up of 12 months in the recipient returning to dialysis without immunosuppression. The recipient of the contralateral donor kidney showed no signs of malignancy at the time of publication. Ureter stenosis at the proximal location in the early period after KTX may be suspicious for obstruction of the ureter by urothelial carcinoma as shown retrospecitvely after graftectomy and proper workup of the removed graft. Early after KTX occuring DISTAL stenosis of the ureter, though, is more likely linked to complications of the ureterovesical anastomosis whereas early PROXIMAL stenosis of the ureter may often be a result of ischemic complication. In contrast LATE ureter stenosis is known to be caused by multiple etiologies including urothelial carcinoma. Upper tract urothelial carcinoma is a rare event (incidence 1/100000/yr) and accounts for 5-7% of all renal tumors. Depending on staging at time of diagnosis in transplant recipients, survival is variable as well as what therapeutic intervention become necessary beyond graft-ureter-ureterocystic anastomosis and discontinued immunosuppression.
Demonstration of imputability or root cause: 
DNA typing: PCR-based Short Tandem Repeat analysis of donor kidney tissue and tumor
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
Malignancy
Case Report
Deceased donor
Kidney transplant
DNA typing
Kidney and urinary tract
Urothelial (transitional) cell carcinoma
Suggest references: 
Huurman VAL, Baranski AG, Groeneveld JHM, Keizer KM, Schaapherder AFM. Transfer of ureteral carcinoma in a transplanted kidney presenting by early stenosis of the proximal ureter. Clinical transplantation. 2008;22(6):847-50.
Note: 
CLFF: we have had two casses of urothel carcinoma deceased donor derived in Germany (2018/2017) which are not published yet (one case: similar to study). Second review done on September 30, 2018 (Kerstin)
Expert comments for publication: 
Unique case: whenever a ureter stenosis occurs, even at a very early stage after transplant, urothelial malignancy should be investigated.