High grade renal cell carcinoma in a simultaneous pancreas and kidney transplant recipient.

Introduction and importance: Renal transplant recipients have a higher risk for developing cancers compared to the general population due to high-dose immunosuppression. The risk of renal cell carcinoma (RCC) in native kidneys is 7-fold greater than the general population and development of RCC in an allograft kidney is extremely rare. We report the diagnosis and management of a large RCC in an allograft renal transplant and metastatic disease in a regional lymph node.

Case presentation: A 46 year old male patient with a history of simultaneous pancreas and kidney transplant presented with visible haematuria. His pancreas allograft continued to function well however following severe BK nephritis his renal transplant failed. A CT urogram demonstrated a 6 cm contrast enhancing mass in the failed renal transplant and an enlarged pelvic lymph node. He underwent a transplant nephrectomy with excision of the metastatic lymph node deposit.

Clinical discussion: We report the diagnosis and management of a large RCC in an allograft renal transplant and metastatic disease in a regional lymph node. There is currently no guidelines on the management of allograft RCC.

Conclusion: Our case report shows that surgical excision of a large RCC in an allograft renal transplant is possible.