Kidney transplantation in patient with malignant disease history

Radmila Bracanovic, BSN, Marina Ratkovic, MD PhD, Danilo Radunovic, MD, Vladimir Prelevic, MD, Zorica Rasovic, BN,

Dragana Velimirovic, BN, Jelena Krstajic, BN, Snezana Bosnic, BN, Snezana Mitrovic, BSN, Darka Fustic, BN

Nephrology and Hemodialysis Department , Clinical Center of Montenegro , Podgorica, Montenegro;

BACKROUND MATERIALS AND METHODS

Patients with ESRD (end stage

renal disease) who have been

successfully treated for cancer are

generally considered to be

suitable for renal transplantation.

The incidence of colon cancer in

renal transplant recipients in not

elevated during the first 10 years

after transplantation. It is

recommended to wait at least 5

years before transplantation for

patients treated for colon cancer

(graph 1.)

Case report study

1.Stratta P, Morellini V, Musetti C, Turello E, Palmieri D, Lazzarich E, Cena T, Magnani C: Malignancy after kidney transplantation: results of 400 patients from a single center., Clinical Transpl2011, 22:424–427.

2. Wong G, Howard K, Chapman JR, Chadban S, Cross N, Tong A, et al. (2012) Comparative Survival and Economic Benefits of Deceased Donor Kidney Transplantation and Dialysis in People with Varying Ages and Co-Morbidities. PLoS ONE 7(1): e29591.

Patient was treated with living related kidney

transplantation. He was treated with basiliximab,

cyclosporine, mycophenolate mofetil and

prednisolone. He was converted in sirolimus regimen

three months after transplantation. Patient is under

frequent oncology controls with good graft function. In

case of someat increased risk of recurrence a longer

waiting interval of 5 years should be considered. The

risk of tumor recurrence has to be balanced against

the benefits of renal transplantation for each patient

(graph 2.)

REFERENCES

Male patient, 58 years, was diagnosed with

pulmonary sarcoidosis 25 years ago. He was on

prednisolone therapy. By the time he developed extra

pulmonary manifestations including bilateral kidney

calcifications and CKD 23 years ago. He had total

thyreoidectomy in 1991 due to medullary thyroid

cancer. Six years ago he was diagnosed colon

adenocarcinoma in C2pT3N2B stage with secondary

deposits in lymph nodes. He was treated with 6

cycles of capecitabine after left hemicolectomy. He

also had splenectomy. He was diagnosed multi

ischemic changes in the brain. From 2011 he

developed arterial hypertension and ESRD. He

started hemodialysis treatment in 2014. He

developed diabetes type 2 two years ago. Control

colonoscopy was done a year ago and three polyps

were removed. Histopathological analyses showed

low grade dysplasia. Tumor markers, CT tomography

of whole body showed no recurrence of malignant

disease. PET scan of whole body was performed

twice in last year and showed no signs of malignant

disease (figure 1.)

RESULTS

CONCLUSIONS

Graph 1. Mortality secondary to malignancy

In CKD patients

Figure 1. Whole Body PET scan

Rejection

Infections

Tumors

Toxicity

Graph 2. Risk/ benefit od immunosuppressive therapy