Successful second kidney transplantation following cured metastatic rectal cancer after first kidney transplantation, 20-year history: A case report

Solid organ transplant recipients face an elevated risk of malignancies due to immunosuppressive drugs and viral infections. Colorectal cancer is a common malignancy in kidney transplant (KT) recipients, with liver metastasis associated with worse. This case report highlights the successful resolution of colorectal cancer with liver metastasis following KT and subsequent triumph in a second KT after the cancer cure. A man who had undergone KT 10 years earlier presented with rectal bleeding. He was diagnosed with rectal cancer with no distant metastasis and recurrence of renal failure, with a creatinine level of 2 mg/dL. He underwent an anterior resection of a pathologic T3N0M0 tumor without risk features. Three months after surgery, a liver metastasis was detected, and a metastasectomy was performed. After the metastasectomy, the patient’s renal function further declined, and his creatinine levels increased from 5 mg/dL to over 12 mg/dL. A consultation to discuss adjuvant chemotherapy was postponed in favor of discussions regarding dialysis. He visited the oncologic clinic to discuss adjuvant treatment options 7 months post-metastasectomy. The decision was made to monitor for cancer recurrence without adjuvant therapy. The patient remained cancer-free for 5 years, and was declared cured. Another 6 years passed, and he achieved renal recovery through a second KT and maintained good health for the subsequent 2 years. Despite the poor prognosis for posttransplant malignancies, this case underscores the significance of early detection and tailored intervention in achieving successful outcomes for posttransplant malignancies and advocates for considering a second transplantation for cancer-cured patients experiencing organ function loss.