Bilateral renal-cell carcinoma of the native kidneys after renal-transplantation

We report the case of a 45-year-old man who received a cadaveric renal transplant and subsequently developed a bilateral neoplasm of the native kidneys. Two tumors per each kidney were detected and in the left kidney they were cytologically different, one granular and one clear cell type. Bilateral nephrectomy with radical lymphadenectomy was performed, immunosuppression was withdrawn and medrossiprogesterone was administered. A control CT scan 3 months after surgery demonstrated no evidence of neoplastic recurrence, while ultrasonography detected a liver metastasis. The patient subsequently developed a para-neoplastic syndrome and died 7 months after surgery. We believe that all long-term immunosuppressed transplant patients need close observation. Regular imaging of the native kidneys, by ultrasound or CT, should be carried out yearly. Prophylactic bilateral nephrectomy is not desirable because of the loss of the important mechanism of pressure control. mediated by the renine-angiotensin system.