Allograft Nephrectomy for Malignancy: Report of Seven Cases and Review of the Literature

Purpose: Present and discuss seven cases of allograft nephrectomies performed at our institution for malignancy as the primary indication. Methods: We reviewed retrospectively all patients undergoing allograft nephrectomy at our institution from January 2002 to May 2015. Results: Over a 13 year period, we performed 74 allograft nephrectomies, of which 7 (9.5%) were indicated for malignancy. All 7 cases underwent angiographic embolization of the allograft prior to removal; 3 cases involved renal cell carcinoma (RCC), including 2 in previously failed allografts. Both of these patients are currently disease-free and receiving chronic immunosuppression for functioning kidney retransplants. The third case involved metastatic (and probably recurrent) RCC in a failing allograftin a patient who previously underwent radical native nephrectomy for RCC. Two cases involved transitional cell carcinomas (TCC); both were discovered during evaluation of acute kidney injury. Both are currently disease-free following allograft nephrectomy and cessation of immunosuppression. The last 2 cases were donor derived malignancies (myeloid sarcoma) in two separate recipients who received kidneys from the same donor. Both patients survived for at least one year following nephrectomy. Conclusions: The above cases are representative of the spectrum of malignant disorders (de novo, recurrent, or donor-derived) that may affect either the functioning or failed renal allograft and result in nephrectomy. Although most recent literature has emphasized the role of nephron-sparing procedures, allograft nephrectomy remains the treatment of choice in selected cases.