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