Transmission of a pancreatic adenocarcinoma to a renal transplant recipient

Transmission of donor tumours in solid organ transplant recipients is rare, but has been reported with fatal outcome in some cases depending on the original tumour type and location. We report a case of a pancreatic adenocarcinoma of donor origin presented as lymphangitis carcinomatosa of the lung in a renal transplant recipient 9 months after transplantation, which is likely to have contributed to the death of the patient 15 months after transplantation. The donor tumour was originally diagnosed on adrenal tissue removed from the donor kidney during bench preparation. At the time of the diagnosis this kidney and the liver of the multi-organ donor had been transplanted. The liver patient was urgently retransplanted within 24 h. The renal recipient opted not to have a transplant nephrectomy having been made aware of the risk of tumour transmission. The contralateral kidney was discarded. Management of recipients with potential transmission of initially undiagnosed donor malignancy is difficult. Early transplant nephrectomy may be the safest option.