A Case of Rapidly Progressing Urothelial Carcinoma Arising After Living Donor Kidney Transplantation Treated with Chemotherapy and Immune Checkpoint Inhibitors.

Abstract

The incidence of malignancy following long-term immunosuppression is increased in organ transplant recipients. We report a case of a patient with right ureteral and bladder cancer after living donor kidney transplantation for chronic glomerulonephritis and who was administered chemotherapy and immune checkpoint inhibitors. A 75-year-old male, 20 years post-living donor kidney transplantation for chronic glomerulonephritis, presented with malignant cells in urinary cytology. Despite initial treatments including transurethral resection of the bladder tumor, the tumor progressed to high-grade urothelial carcinoma. Computerized tomography results showed a right ureteral tumor and multiple lymph node metastases. Therefore, the patient underwent systemic chemotherapy with four cycles of gemcitabine and carboplatin. Pembrolizumab was administered due to rapid cancer progression; however, the cancer progressed further, and the patient was treated palliatively. The patient was treated with an immune checkpoint inhibitor with a reduced dose of immunosuppressive drugs with no rejection during the treatment course.