Early-onset lung metastasis from renal cell carcinoma after laparoscopic primary nephrectomy in a kidney transplant patient: a case report

Introduction: Kidney transplantation improves outcomes in end-stage renal disease but increases malignancy risk due to immunosuppression, with renal cell carcinoma (RCC) is 10–30 times more common. Early-onset RCC with rapid metastasis is rare, posing screening and treatment challenges. Case presentation: A 63-year-old man, 10 months post-kidney transplant, developed a 15 × 16 mm native-kidney clear cell RCC (pT1a) that was treated with laparoscopic nephrectomy. Three months later, pulmonary metastasis with pleural effusion was confirmed. Pazopanib (800 mg/day) and thoracoscopic adhesiolysis achieved a partial response. Clinical discussion: The presence of sarcomatoid differentiation in the metastasis underscores the aggressive potential of even small RCCs. The patient’s subsequent management with targeted therapy (pazopanib and everolimus) and video-assisted thoracoscopic surgery (VATS) demonstrated a positive clinical response, highlighting the efficacy of a multidisciplinary approach. Conclusion: Routine post-transplant surveillance and tailored therapies (tyrosine kinase inhibitors and mechanistic target of rapamycin inhibitors) are critical. Multidisciplinary care and biomarkers may improve outcomes.