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Renal Transplantation After Laparoscopic Radical Nephrectomy due to Neoplastic Disease – Case Report

Skwirczyńska, Edyta4; Prekwa, Anna1; Serwin, Natalia2; Ostrowski, Marek3

doi: 10.1097/01.tp.0000520316.56337.5c
116.13
Free

1Department of History of Medicine and Ethics, Pomeranian Medical University of Szczecin, Szczecin, Poland; 2Department of General Surgery and Transplantation, Pomeranian Medical University in Szczecin, Szczecin, Poland; 3Department of Microbiology and Immunology, Pomeranian Medical University in Szczecin, Szczecin, Poland; 4Department of General Surgery and Transplantation, Pomeranian Medical University in Szczecin, Szczecin, Poland.

A 36-year-old doctor, came to the Clinical Department of Urology and Urological Oncology of Pomeranian Medical University because of the recognized left kidney tumor on computed tomography. Due to the suspicious nature of the tumor (carcinoma clarocellulare), the patient was qualified for laparoscopic left radical nephrectomy. During laparoscopic nephrectomy procedure, hilus of kidney neoplasm with a diameter of 3 centimeters was found. The kidney was removed. On a side table, the kidney was rinsed with Custodiol ® fluid and macroscopic evaluation of the tumor`s morphology was conducted. Then, the tumor with capsule was removed and the incision was closed with single sutures. The kidney was placed on a Lifeport perfusion machine. Kidney tumor was sent to the Depatment of Anatomical Pathology for histopathological examination. The initial result indicated oncocytoma. The patient did not agree to autotransplantation of the removed kidney. On the other hand, she proposed a kidney transplant for her mother undergoing peritoneal dialysis for over four months. After fulfilling all the necessary formalities (informed consent of the donor and recipient, crossmatch test) after 16 hours of removal, the kidney was transplanted into the patient's mother. After the transplant, a proper function of the kidneys was restored. In a postoperative period following complications were observed – anastomotic vesicoureteral leak, which was surgically cured, (most likely caused by too early administration of Rapamune ®) and anastomotic stenosis of renal artery treated with stenting. The final result of histological examination, obtained 14 days after transplantation, was a chromophobic cancer without capsule infiltration. The recipient was informed of the possible consequences of transplantation. The case was presented to an oncology committee. At present, after 14 months, renal function is normal with creatinine level of 1.1. In both the donor and the recipient, no evidence of neoplastic disease is observed. Currently, the recipient receives immunosuppressive agents: CellCept ®500 mg 2x1, Certikan ® 0,5 mg 2x1, Metypred ®2 mg 1x1.

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