title: Urothelial carcinoma of donor origin in a kidney transplant patient.
abstract: Malignancy after transplantation is an uncommon multifactorial occurrence. Immunosuppression to prevent graft rejection is described as a major risk factor in malignancy development in the post-transplant state. Donor-derived malignancy is a rare reported complication. Herein, we review our patient history and discuss diagnostic strategies and the implications of immunosuppression for donor-derived malignancy.
  
  
  
  This is a 69-year-old man with post-renal-transplant urothelial carcinoma determined to be of donor origin. His course was complicated by BK virus at six years post-transplant; urothelial carcinoma was identified nine years post-transplant. Cystectomy was performed, but because of immunosuppression and underlying chronic kidney disease, the patient was considered ineligible for adjuvant chemotherapy. Two years after resection, screening MRI demonstrated retroperitoneal lymphadenopathy and a right upper pole mass in the transplanted kidney. Urine cytology confirmed the presence of malignant cells; FISH showed 2-8 copies of the X chromosome and no Y chromosome consistent with female origin of the malignant cells. CT-guided renal mass and paraaortic lymph node biopsies demonstrated that about 50 % of cells had an XY complement, while the remainder showed a XX genotype by chromosomal SNP microarray analysis. Immunosuppression was discontinued and the donor kidney removed. X/Y FISH of the urothelial carcinoma identified in the explanted kidney confirmed that the malignant cells were of female donor origin. Follow-up at 3, 6 and 12 months after discontinuation of immunosuppression and surgery demonstrated normalization of the lymphadenopathy and absence of new lesions.
  
  
  
  Immunosuppression is a major risk factor for development of malignancy in transplant recipients. Donor-derived malignancy can arise and current molecular studies allow an accurate diagnosis. Withdrawal of immunosuppression and surgical resection of the transplant kidney proved an effective treatment in our case.
authors: Division of Hematology and Oncology, Medical University of South Carolina, 173 Ashley Ave, Suite 102 BSB, Charleston, SC 29425 USA.
authors: Rosa M
authors: RM
authors: Michel Ortega
authors: Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, SC USA.
authors: Daynna J
authors: DJ
authors: Wolff
authors: Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, SC USA.
authors: Cynthia A
authors: CA
authors: Schandl
authors: Division of Hematology and Oncology, Medical University of South Carolina, 173 Ashley Ave, Suite 102 BSB, Charleston, SC 29425 USA.
authors: Harry A
authors: HA
authors: Drabkin
mesh_terms: D000368:Aged; D001739:BK Virus; D002869:Chromosome Aberrations; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000009:adverse effects; D017404:In Situ Hybridization, Fluorescence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D027601:Polyomavirus Infections / Q000150:complications / Q000821:virology; D014019:Tissue Donors; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous; D014412:Tumor Virus Infections / Q000150:complications / Q000821:virology; D014571:Urologic Neoplasms / Q000175:diagnosis* / Q000209:etiology* / Q000235:genetics / Q000628:therapy
chemical_list: D007166:Immunosuppressive Agents
keywords: Immunosuppression; Post-transplant malignancy; Solid organ transplantation; Urothelial carcinoma