title: Determining eligibility for and preparation to kidney transplantation of a patient with Lynch syndrome--a case report and literature review.
abstract: BACKGROUND
  Lynch syndrome (HNPCC, hereditary non-polyposis colorectal cancer) is a syndrome of predisposition to cancer inherited in an autosomal dominant fashion. A person with Lynch syndrome has a considerably increased risk of colorectal cancer in comparison with the general population.
  
  
  METHODS
  We present a case of a 24-year-old man with Lynch syndrome (carrying an MLH1 gene mutation) who had colorectal adenocarcinoma diagnosed at 16 years of age. During this time, he had a colectomy performed and chemotherapy was administered (5-FU, CDDP, Leucovorin). Due to hepatic metastases, a decision was made to change chemotherapy to IF with ADM, as a result of which complete remission was obtained. However, kidney failure developed. Its cause was not fully elucidated. The patient was treated by hemodialyses. After six years of complete remission of cancer, kidney transplantation started to be considered. Before the patient was found eligible for transplantation, extended diagnostic tests were performed: whole body PET scan, tumour marker tests and intestinal endoscopy, which did not reveal any abnormalities. The patient had a family donor (mother) who had no contraindications to kidney donation. Kidney transplantation was performed on 15/10/2012. Induction with basiliximab was used, along with steroids, tacrolimus, and mycophenolate mofetil was also administered. Three months after the procedure CNI/mTOR conversion was performed. The maintenance treatment includes prednisone, everolimus and mycophenolate mofetil. One year after transplantation, renal function is normal. The patient is subjected to close oncological surveillance.
  
  
  CONCLUSIONS
  The risk of recurrence or new development of cancer related to immunosuppressive treatment should be considered on a case-by-case basis. In patients with a history or high risk of cancer, immunosuppression protocols based on the m-TOR pathway inhibitors should be used, if possible. Oncological surveillance and early detection of new cancer lesions are also important.
authors.affiliation: Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Institute of Transplantology, Warsaw, Poland.
authors.forename: Jolanta
authors.initials: J
authors.lastname: Gozdowska
authors.affiliation: Department of General and Transplantation Surgery, Medical University of Warsaw, Institute of Transplantology, Warsaw, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Bieniasz
authors.affiliation: Department of General and Transplantation Surgery, Medical University of Warsaw, Institute of Transplantology, Warsaw, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Wszoła
authors.affiliation: Department of General and Transplantation Surgery, Medical University of Warsaw, Institute of Transplantology, Warsaw, Poland.
authors.forename: Rafał
authors.initials: R
authors.lastname: Kieszek
authors.affiliation: Department of General and Transplantation Surgery, Medical University of Warsaw, Institute of Transplantology, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Domagała
authors.affiliation: Department of General and Transplantation Surgery, Medical University of Warsaw, Institute of Transplantology, Warsaw, Poland.
authors.forename: Jakub
authors.initials: J
authors.lastname: Drozdowski
authors.affiliation: Department of General and Transplantation Surgery, Medical University of Warsaw, Institute of Transplantology, Warsaw, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Tomaszek
authors.affiliation: Department of General and Transplantation Surgery, Medical University of Warsaw, Institute of Transplantology, Warsaw, Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Kwiatkowski
authors.affiliation: Department of General and Transplantation Surgery, Medical University of Warsaw, Institute of Transplantology, Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Chmura
authors.affiliation: Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Institute of Transplantology, Warsaw, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Durlik
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000188:drug therapy*; D006801:Humans; D007157:Immunologic Surveillance; D016030:Kidney Transplantation; D008297:Male; D018579:Patient Selection; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000601:surgery*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents