Simultaneous Radical Nephrectomy and Kidney Transplant in a Recipient with Incidentally Detected Clear Cell Papillary Renal Cell Carcinoma: A Case Report

Introduction: Kidney transplant recipients are at increased risk of developing renal cell carcinoma (RCC), which can occur at various stages during the transplantation process. Generally, renal transplantation is contraindicated in patients with cancer, requiring a specific follow-up period before proceeding. However, the unpredictable timing of deceased donor transplants complicates comprehensive pre-transplant RCC screening. Currently, there are no established guidelines for the management of RCC incidentally discovered in transplant recipients prior to surgery. Clear cell papillary renal cell carcinoma (CCPRCC), a low-grade RCC subtype classified by the WHO in 2016, has been identified in patients with end-stage renal disease (ESRD). This case highlights the critical importance of thorough pre-transplant evaluation and the potential need for simultaneous surgical interventions for the incidental detection of malignancies. Case Description: A 57-year-old female with chronic glomerulonephritis progressed to end-stage renal disease (ESRD). Initially treated with peritoneal dialysis, she transitioned to hemodialysis. A pre-transplant CT scan for a deceased donor kidney revealed a 1.4 cm mass in the left native kidney, suspected to be renal cell carcinoma (RCC). She underwent simultaneous left radical nephrectomy and cadaveric renal transplantation. Histopathological examination confirmed clear cell papillary renal cell carcinoma (CCPRCC) without metastatic spread. The patient demonstrated stable renal function postoperatively and was discharged on the 13th postoperative day, exhibiting favorable recovery. Discussion: This case underscores the critical importance of conducting comprehensive pre-transplant evaluations in patients with end-stage renal disease (ESRD), particularly when incidental renal cell carcinoma (RCC) is detected in the native kidneys. These findings suggest that in cases where clear cell papillary renal cell carcinoma (CCPRCC) is identified preoperatively, simultaneous radical nephrectomy and kidney transplantation may offer an effective therapeutic strategy. This approach not only ensures robust oncologic control, but also facilitates timely transplantation, thereby optimizing patient outcomes.