Korean J Transplant.  2022 Nov;36(Supple 1):S261. 10.4285/ATW2022.F-4034.

DNA test to distinguish de novo transitional cell carcinoma from donor-derived malignancy: a case report

• Ko K
• Kim D
• Jeon HJ
• Jeong HC
• Ko K

• KMID: 2535478
• DOI: http://doi.org/10.4285/ATW2022.F-4034

Abstract

Background
Transitional cell carcinoma (TCC) of urinary tract appears more common in kidney transplantation recipients than in general population. De novo TCC after renal transplantation was treated with transurethral resection of the bladder tumor or partial cystectomy. But, if TCC was derived from donor, the most frequent treatment was removal of graft. Herein, we report on a case in which DNA testing between TCC and the deceased donor blood was performed.
Case report
A 45-year-old male patient underwent renal transplant from a deceased donor (subarachnoid hemorrhage, 52-year-old female). Dysuria and creatinine elevation occurred 34 days after transplant. He was admitted for graft biopsy and double J (DJ) catheter removal. Renal biopsy was revealed as acute T cell-mediated rejection, grade IA. Steroid pulse therapy (500 mg/day) was used for 3 days immediately. Cystoscopy for DJ catheter removal revealed the dysfunction of DJ catheter within neo-ureterocele at ureteroneocystostomy site. transurethral resection of the bladder tumor and DJ catheter change was done after steroid pulse therapy. Pathology of neo-ureterocele was revealed as noninvasive urothelial carcinoma, low grade, inverted pattern. As the possibility of derivation from the deceased donor could not be ruled out, DNA testing was planned between the tissue of TCC and the blood sample of deceased donor. Blood sample of deceased donor was offered from the Korea Organ Donation Agency Laboratory. Male DNA was detected from tissue, but female DNA was detected from the blood sample. Discrepancies were found at 18 gene loci among 20 gene loci. Finally, the TCC was decided as de novo TCC after transplantation. Then, the patient has been followed up every 3 months for cystoscopy test without any abnormality.
Conclusions
Treatment of TCC after transplantation is decided differently whether the cancer was developed de novo or derived from donor. DNA testing could be one of methods for distinguishment of cancer origin.