Metastatic Renal Cell Carcinoma Arising in a Renal Allograft after Two Transplants: Case Report and Implications for Screening

Abstract

Background: Renal cell carcinoma (RCC) arising in a transplanted kidney is rare, accounting for 0.2–0.5% of grafts, but poses serious risks of graft loss and cancer-related mortality.

Case Presentation: We report a 50-year-old kidney transplant recipient who developed metastatic RCC six months after his second living-related transplant. He presented with cough and dyspnea, and imaging revealed multiple pulmonary nodules and a metabolically active cystic lesion in the renal allograft. Ultrasound-guided biopsies of the allograft lesion and a pulmonary nodule confirmed clear cell RCC on histology, supported by immunohistochemistry (PAX8, CD10, and Vimentin positive). Despite the initiation of lenvatinib, his condition deteriorated rapidly, and he died one week after treatment initiation.

Conclusion: This case underscores the difficulty of early detection and management of allograft RCC. It demonstrates the probable value—but uncertain benefit—of a risk-based, rather than universal, surveillance strategy in kidney transplant recipients.