Transplanted kidney loss during colorectal cancer chemotherapy: A case report

Marta Pośpiech; Aureliusz Kolonko; Teresa Nieszporek; Sylwia Kozak; Anna Kozaczka; Henryk Karkoszka; Mateusz Winder; Jerzy Chudek

doi:10.12998/wjcc.v10.i19.6647

Transplanted kidney loss during colorectal cancer chemotherapy: A case report

World J Clin Cases. 2022 Jul 6;10(19):6647-6655. doi: 10.12998/wjcc.v10.i19.6647.

Authors

Marta Pośpiech¹, Aureliusz Kolonko², Teresa Nieszporek³, Sylwia Kozak⁴, Anna Kozaczka⁵, Henryk Karkoszka², Mateusz Winder⁶, Jerzy Chudek¹

Affiliations

¹ Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia in Katowice, Katowice 40-027, Poland.
² Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice 40-027, Poland.
³ Department of Nephrology, Transplantation and Internal Medicine, Mielecki Clinical Hospital of the Medical University of Silesia, Katowice 40-027, Poland.
⁴ Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia in Katowice, Katowice 40-027, Poland. sylwiakozak@icloud.com.
⁵ Department of Internal Diseases and Oncological Chemotherapy, Mielecki Clinical Hospital, Katowice 40-027, Poland.
⁶ Department of Radiology and Nuclear Medicine, Medical University of Silesia in Katowice, Katowice 40-752, Poland.

Abstract

Background: The overall risk of de novo malignancies in kidney transplant recipients (KTRs) is higher than that in the general population. It is associated with long-lasting exposure to immunosuppressive agents and impaired oncological vigilance due to chronic kidney disease. Colorectal cancer (CRC), frequently diagnosed in an advanced stage, is one of the most common malignancies in this cohort and is associated with poor prognosis. Still, because of the scarcity of data concerning adjuvant chemotherapy in this group, there are no clear guidelines for the specific management of the CRCs in KTRs. We present a patient who lost her transplanted kidney shortly after initiation of adjuvant chemotherapy for colon cancer.

Case summary: A 36-year-old woman with a medical history of kidney transplantation (2005) because of end-stage kidney disease, secondary to chronic glomerular nephritis, and long-term immunosuppression was diagnosed with locally advanced pT_4AN_1BM₀ (clinical stage III) colon adenocarcinoma G2. After right hemicolectomy, the patient was qualified to receive adjuvant chemotherapy that consisted of oxaliplatin, leucovorin and 5-fluorouracil (FOLFOX-4). The deterioration of kidney graft function after two cycles caused chemotherapy cessation and initiation of hemodialysis therapy after a few months. Shortly after that, the patient started palliative chemotherapy because of cancer recurrence with intraperitoneal spread.

Conclusion: Initiation of adjuvant chemotherapy for colon cancer increases the risk of rapid kidney graft loss driven also by under-immunosuppression.

Keywords: Adjuvant chemotherapy; Case report; Colorectal cancer; Complications; Graft loss; Kidney transplantation.

Publication types

Case Reports