Sarcomatoid Renal Cell Carcinoma in a Renal Transplant Recipient F. Llamas, E. Gallego, A. Salinas, J. Virseda, J. Pérez, A. Ortega, S.H. Nam, and C. Gómez ABSTRACT The incidence of transplanted kidneys derived from elderly donors is increasing because of the larger waiting lists and greater age of patients with end-stage renal failure. Compared with young donors, one of the problems is the heightened risk of neoplasm transmission. We report 2 cases of kidney recipients, both of whom developed a sarcomatoid renal cell carcinoma after receiving a kidney transplant from the same 68-year-old male donor, who did not show signs of a neoplasm on a previous abdominal ultrasound or a pretransplant biopsy. The first recipient was a 66-year-old woman who developed a kidney mass with several urologic obstructive complications, tumor dissemination, and death at 9 months after kidney transplantation. The second recipient was a 48-year-old asymptomatic man with normal renal function, who was studied after the results of the first recipient, revealing another renal tumor. Transplant nephrectomy was performed and a peritoneal implant was resected. The patient is alive without evidence of a neoplasm after 18 months. Herein we have discussed the mechanisms of neoplasm transmission in kidney trans- plantation and possible strategies for its prevention and treatment. N EOPLASTIC DISEASE is more common among transplant recipients than the general population. Carcinomas may be present in the donor at the time of transplantation despite screening. 1 Renal cell carcinoma occurs in 5% of transplanted patients; among these, 10% arise in renal grafts. 2,3 The Cincinnati Transplant Tumor Registry 4 alone has reported 45 such cases. Many tumors in renal grafts are treated with radical nephrectomy, although partial nephrectomy has been successful in some cases, particularly among single tumors 4 cm. 5 Herein we have described 2 transplant patients, both recipients of organs from the same donor, who had tumors in their renal grafts diagnosed at 7 months after transplan- tation. One subject died from tumor dissemination and postoperative complications. The other underwent radical transplant nephrectomy with locoregional lymph node ex- cision and is currently on dialysis. CASE REPORTS Donor The donor was a 68-year-old man who died from an acute hemorrhagic stroke. The pre-explant ultrasound was normal, and the biopsy (Banff chronic score 2) showed no signs of malignancy. Blood type was A and human leukocyte antigen (HLA) pheno- type was: HLA-DR7, DR17, B18, B50, A2, and A30. The donor was positive for cytomegalovirus immunoglobulin G (CMV IgG). Recipient 1 The first recipient was a 66-year-old woman who had started hemodialysis in 2002 for probable chronic glomerulonephritis. In June 2006, she received a cadaveric kidney transplant, iso blood group with 2 HLA incompatibilities. Induction therapy consisted of basiliximab, tacrolimus, mycophenolate mofetil, and prednisone. Maintenance therapy included tacrolimus and mycophenolate. There were no rejection episodes. One month later, obstructive uropathy developed from a lymphocele, which was subsequently drained by marsupialization. Obstructive uropathy recurred at 3 months due to ureterovesical stenosis; which was treated with a double-J catheter. Kidney function had been good with creatinine values of 1.5–1.8 mg/dL except during the episodes of obstructive uropathy. In January 2007 the patient was admitted after several days of fever, dyspnea, orthopnea, edema, decreased diuresis, and loose stools. Repeated urine cultures were negative. An ultrasound of the renal graft revealed calyceal ectasia with fine lines of perihepatic and perigraft fluid. Descending pyelography showed filiform ste- nosis of the ureter. After nephrostomy, the fever persisted and the kidney function continued to deteriorate. Eighteen days later, magnetic resonance imaging (MRI) revealed a fluid collection From the Department of Nephrology University Hospital of Albacete, Albacete, Spain. Address reprint requests to Dr Francisco LLamas, University Hospital of Albacete, Hnos Falce 37, Albacete 02006, Spain. 0041-1345/09/$–see front matter © 2009 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2009.08.066 360 Park Avenue South, New York, NY 10010-1710 4422 Transplantation Proceedings, 41, 4422– 4424 (2009)