Malignancies In Kidney Transplant Recipients Research Articles

Immune Checkpoint Inhibitor Therapy for Kidney Transplant Recipients - A Review of Potential Complications and Management Strategies.

Immune checkpoint inhibitor (ICI) therapy has enabled a paradigm shift in Oncology, with the treatment of metastatic cancer in certain tumor types becoming akin to the treatment of chronic disease. Kidney transplant recipients (KTR) are at increased risk of developing cancer compared to the general population. Historically, KTR were excluded from ICI clinical trials due to concern for allograft rejection and decreased anti-tumor efficacy. While early post-marketing data revealed an allograft rejection risk of 40%-50%, 2 recent small prospective trials have demonstrated lower rates of rejection of 0%-12%, suggesting that maintenance immunosuppression modification prior to ICI start modulates rejection risk. Moreover, objective response rates induced by ICI for the treatment of advanced or metastatic skin cancer, the most common malignancy in KTR, have been comparable to those achieved by immune intact patients. Non-invasive biomarkers may have a role in risk-stratifying patients before starting ICI, and monitoring for rejection, though allograft biopsy is required to confirm diagnosis. This clinically focused review summarizes current knowledge on complications of ICI use in KTR, including their mechanism, risk mitigation strategies, non-invasive biomarker use, approaches to treatment of rejection, and suggestions for future directions in research.

Genitourinary malignancies in kidney transplant recipients.

Advances in immunosuppressive therapy and postoperative management have greatly improved the graft and patient survival rates after kidney transplantation; however, the incidence of post-transplant malignant tumors is increasing. Post-renal transplantation malignant tumors are associated with renal failure, immunosuppression, and viral infections. Moreover, the risk of developing cancer is higher in kidney transplant recipients than in the general population, and the tendency to develop cancer is affected by the background and environment of each patient. Recently, cancer after kidney transplantation has become the leading cause of death in Japan. Owing to the aggressive nature and poor prognosis of genitourinary malignancies, it is crucial to understand their epidemiology, risk factors, and best practices in kidney transplant recipients. This review has a special emphasis on the epidemiology, risk factors, and treatment protocols of genitourinary malignancies in kidney transplant recipients to enhance our understanding of the appropriate management strategies. Optimal immunosuppressive therapy and cancer management for these patients remain controversial, but adherence to the general guidelines is recommended.

Metastasis of skin squamous cell carcinoma in kidney transplant recipients.

Cutaneous squamous cell carcinoma (cSCC) is the most common skin malignancy in kidney transplant recipients (KTRs) as a result of immunosuppression. A worldwide increase in kidney transplantation justifies the determination of prognostic biomarkers by collecting detailed patient data on metastasis development. This study aims to characterize the clinical, epidemiological, and histopathological profiles of KTRs who developed metastasis of cSCC. We conducted a retrospective single-center study on 18 KTRs and 21 immunocompetent patients (ICs) with metastatic cSCC, using data from 2004 to 2021. ICs were older (median age 70.5 years) than KTRs (median age: 59.5 years). Both groups were predominantly male with Fitzpatrick skin phototype I/II. The primary tumor appeared around 83.5 months post-transplant, usually in sun-exposed areas (61.1%), though some non-exposed areas in ICs (23.8%) contradicted literature findings. KTRs took longer to develop metastasis (median: 11.0 months) compared to ICs (median: 5.5 months). The mean size of the primary tumor was smaller in KTRs (2.50 cm2) compared to ICs (4.55 cm2). The main lymph node chain affected by metastasis wasparotid lymph nodes in KTRs (27.8%) and cervical/axillar lymph nodes in ICs (both 19.0%). Both groups exhibited similar primary tumor grades and metastasis evolution, but KTRs had a higher prevalence of lymphovascular invasion. Metastasis of cSCC was more common in males with low skin phototype, in KTRs, particularly on the head and neck. The study suggests a possible link between lymphovascular invasion and metastasis development in KTRs.

Association of human leukocyte antigen homozygosity and de novo malignancies in kidney transplant recipients

Association of human leukocyte antigen homozygosity and <i>de novo</i> malignancies in kidney transplant recipients

Sonidegib induced rhabdomyolysis in kidney transplant patient: a case report

Kidney transplant recipients (KTR) have a higher risk of developing malignancies compared to the general population, due to the immunosuppressive regimens which can promote the oncogenesis process. The incidence of de novo non-melanoma skin cancer (NMSC) in KTR is greater than in the general population. Basal cell carcinoma (BCC) represents one of the most frequent malignancies in KTR. Sonidegib is a Hedgehog signaling pathway inhibitor approved for the treatment of locally advanced basal-cell carcinoma (LABCC) that following surgery or radiation therapy, or is given to those candidates who are not eligible to surgery or radiation therapy. This paper reports the case of a kidney transplant patient, who developed severe acute kidney injury (AKI) due to rhabdomyolysis (RML) induced by sonidegib therapy which required renal replacement therapy (RRT).

De Novo Malignancies After Kidney Transplant: Where Do We Stand and Does the Head and Neck Region Require More Caution?

The aim of this study was to investigate the characteristics of de novo malignancies arising in kidney transplant recipients followed in a tertiary hospital in Turkey and to examine the tumors in the head and neck region as a subgroup. Data from kidney transplant recipients treated at our institution between January 2010 and July 2022 were retrospectively analyzed in this single-center study. Data regarding malignancies were noted according to the pathologists' reports. In situ malignancies and those arising after graft loss were not evaluated. The study population comprised 231 patients (165 men; 71.4%) with a median follow-up of 11 years (2853 patient-years). The recipients had a higher cancer risk than the general population (standardized incidence rate = 3.04; 95% CI, 1.82-4.26). Thirty de novo malignant tumors were detected in 24 patients (10.4%). The mean age at diagnosis of cancer was 54.88 ± 11.44 years. The median time from transplant to cancer diagnosis was 11.5 years (range, 7-18.8 y). Nonmelanoma skin cancers (56.7% of all tumors) were the most common malignancies. Twenty-two lesions (73.3%) that developed in 17 patients (7.4%) were localized to the head and neck region: 15 (68.2%) were cutaneous and 7 (31.8%) were noncutaneous. The median time from transplant to head and neck cancer diagnosis was 12 years (range, 7.5-17.5 y). Mortality rate was higher in cancer patients (10 [41.7%] vs 17 [8.2%]; P < 0.01). The incidence of de novo malignancy in kidney transplant recipients was relatively higher compared with previous data. Nonmelanoma skin cancers were the most common type. Three-quarters of all lesions were in the head and neck region, and two-thirds were of cutaneous origin.

Late malignant oral lesions after kidney transplantation

Objective: To review cases of oral cavity malignancies available in the literature in kidney transplant recipients. Methods:A search was carried out in the PubMed database using the terms “oral cancer,” “mouth neoplasms,” “renal transplantation,” and “kidney transplantation.” Regardless of the publication date, the publications were chosen by two researchers after they carefully considered the titles and abstracts and read each article in its entirety. Results: Twelve articles were found with cases of oral malignancies in kidney transplant recipients. In all, 31 malignant neoplasms were diagnosed in the oral cavity, of which 64.5% (20/31) were squamous cell carcinomas; Kaposi’s sarcoma represented 12.9% (4/31) of the cases. Lips and tongue were the most affected sites mentioned most frequently in the articles evaluated. Post-transplantation time ranged from 8 months to 23 years, and several immunosuppressants were used. Conclusions: Kidney transplant recipients should be regularly forwarded to dentists and other medical professionals who work in diagnosing malignant lesions of the oral cavity to be evaluated, and new cases of oral cancer can be recognized early to treatment. This strategy could improve the survival of patients with this threatening disease.

P8.149: Development of Post-transplant Malignancy in Kidney Transplant Recipients

P8.149: Development of Post-transplant Malignancy in Kidney Transplant Recipients

Risk Factors and Incidence of Malignancy After Kidney Transplant in Mainland China: A Single-Center Analysis.

Malignancy is a common cause of death in renal transplant patients. The aim of this study was to investigate incidence, risk factors, and survival rates associated with posttransplant malignancy in kidney transplant recipients. Between January 2015 and December 2020, 1154 patients underwent kidney transplant at the Affiliated Hospital of Qingdao University. Patients with a history of malignancy or other organ transplant(liver, pancreas, heart, orlungs) were excluded from this study. Patients with incomplete follow-up records were also excluded. Ultimately, our study comprised 811 kidney transplant recipients. The patient characteristics and incidence, type, and risk factors associated with posttransplant malignancy were examined. We also analyzed the overall survival of recipients with posttransplant malignancy. A total of 811 renal transplant recipients were followed up, with a median follow-up period of 3.0 years. Fourteen kidney recipients developed posttransplant malignancy (1.7%), with a mean time to malignancy diagnosis of 2.7 years. The 3-year and 5-year overall survival rates were 91.7% and 91.7%, respectively, in recipients with malignancy and 99.2% and 98.8%, respectively, in recipients without malignancy. The overall survival rate was significantly higher in recipients without malignancy than in those with malignancy (P = .03). Female sex, older recipient age, and history of prior kidney transplant were significant predictors of malignancy development. Postoperative malignancy in kidney transplantrecipients was associated with lower overall survival rates. Malignancy screening is important for kidney transplant patients, especially for older women and patients with a history of prior kidney transplant.

MO988: Malignancy After Kidney Transplantation: A Two-Center Experience

Abstract BACKGROUND AND AIMS Kidney transplantation (KT) is the preferred treatment option for patients with end-stage renal disease (ESRD) as it provides better patient survival and quality of life. While longer graft survival is maintained with potent immunosuppressive drugs used to prevent allograft rejection, de novo malignancy development after transplantation has become a substantial issue. In this study, we aimed to investigate the incidence and risk factors of post-transplant malignancy in kidney transplant recipients, including its demographic, clinical and laboratory features. METHOD A retrospective cohort study was conducted at two tertiary care kidney transplant centers in the same province. We recruited adult (&amp;gt;18 years of age) kidney transplant recipients who underwent kidney transplantation between 1986 and 2020. We excluded KT recipients who lost to follow-up in the early post-transplant period and/or with incomplete records. Malignancies that occurred after graft failure were also excluded. Kidney transplant recipients with malignancy were matched to KT recipients without malignancy using a 1:1 ratio. RESULTS In this study, 2750 eligible patients were reviewed for the development of malignancy after kidney transplantation. A total of 278 KT recipients (10.1%) had biopsy confirmed malignancies during the follow-up period. The median post-transplant follow-up time was 217 months (IQR: 148–290 months). The most common malignancies were nonmelanoma skin cancer (28.8%), urinary tract cancer (16.5%), Kaposi's sarcoma (9.7%), gastrointestinal tract cancer (6.5%) and post-transplant lymphoproliferative disease (6.5%). The median time from kidney transplantation to the diagnosis of malignancy was 127 months (IQR: 62–198 months). In comparison to the control group, patients with malignancy were older (P ≤ 0.001), had a higher family history of malignancy (P ≤ 0.001), had a greater history of smoking (P = 0.005), and usage of erythropoietin in the pre-transplant period was higher (P ≤ 0.001). There was no significant difference between the two groups in terms of gender and the type of induction therapy. Overall mortality was higher in patients with malignancy (OR: 2.491 [CI: 1.586–3.912], P &amp;lt; 0.001). CONCLUSION The most common malignancy in kidney transplant recipients was found to be non-melanoma skin cancer. Elderly recipients, patients with a family history of malignancy and patients using erythropoietin in the pre-transplant period should be closely monitored for the development of malignancy.

Risk of malignancy in kidney transplant recipients: a nationwide population-based cohort study

BackgroundPost-transplant malignancy is major morbidity complicated in kidney transplantation (KT). In Korea, a few studies have investigated the sex- and age-dependent risk for post-transplant malignancy among KT recipients on a large scale.MethodsWe utilized a national health insurance database in Korea to investigate the relative risk of post-transplant malignancy in 12,634 KT recipients between 2007 and 2017. The same number of patients with acute appendicitis was included as a control group. The relative risk of malignancy was estimated using a multivariable-adjusted Cox model, and interaction analysis was performed to investigate age- and sex-predominant patterns.ResultsKT recipients had an overall 1.8-fold higher risk for post-transplant malignancy with an increased risk for 14 of 29 cancer types, among which Kaposi’s sarcoma, non-Hodgkin’s lymphoma, kidney, uterus, and bladder/urinary tract cancers were most prominent. Although the overall risk for post-transplant malignancy was similar between male and female KT recipients, head and neck cancer had a higher risk among male KT recipients, whereas non-Hodgkin’s lymphoma and bladder/urinary tract cancer had a higher risk among female KT recipients. Overall, the young (< 50 years) KT recipients had a higher risk for post-transplant malignancy than older ones (≥ 50 years), whose pattern was most prominent in non-Hodgkin’s lymphoma. In contrast, breast and nonmelanoma skin cancer showed a higher risk among older KT recipients.ConclusionKT recipients had an increased risk for a wide range of cancer types, some of which showed differential risk patterns with age and sex. Our result suggests that focused screening for predominant post-transplant malignancies may be an effective strategy for selected KT recipients.

Carcinogenicity risk associated with tacrolimus use in kidney transplant recipients: a systematic review and meta-analysis.

BackgroundCurrently, tacrolimus is the preferred anti-rejection therapy for kidney transplant recipients due to its greater protection against acute rejections compared to cyclosporin A (CsA). Despite the advantages of kidney transplantation, it has been associated with an increased incidence of de novo malignancies. Furthermore, a systematic review in 2005 revealed no statistical difference in tumorigenicity between tacrolimus and CsA. This report provides an up to date systematic review and evaluation of all relevant studies in the literature to determine the risk of malignancy in kidney transplant recipients exposed to tacrolimus.MethodsA systematic literature search was performed using the Medline (PubMed and Ovid), Embase, Clinical Trials, and Cochrane databases (from creation to May 2021). We performed a meta-analysis of 11 studies with 36,985 kidney transplant recipients that compared the tacrolimus group with the control group. Outcomes of this study were incidence of malignancies and skin cancer risk. Risk of Bias was assessed in terms of whether there was random sequence generation, allocation concealment, blinding, completeness of results, selective reporting, etc. This meta-analysis was performed in accordance with PRISMA guidelines.ResultsOf the 11 included studies, 8 were high quality studies, 1 was assessed as medium quality, and 2 were low quality studies. The results showed a significantly increased risk of overall malignancy associated with tacrolimus exposure compared to non-tacrolimus therapy [risk ratio (RR) =1.59; 95% confidence interval (CI): 1.19–2.11; P=0.002], and especially with sirolimus (SRL) (RR =2.58; 95% CI: 1.62–4.09; P<0.0001). The incidence of skin cancer was consistent with the overall study (RR =2.03; 95% CI: 1.25–3.28; P=0.004). However, there was no significant difference in the incidence of tumors between tacrolimus and cyclosporine A treatment (RR =1.12; 95% CI: 0.80–1.56; P=0.52), even in studies with long follow-up periods of more than 3 years.DiscussionThe data demonstrated that patients treated with tacrolimus had a higher risk of carcinogenicity compared to patients treated with SRL. However, patients treated with tacrolimus had a similar incidence of carcinogenicity compared to patients treated with CsA. Further clinical studies are warranted to confirm these findings.

Malignancies in renal transplant recipients: A retrospective single-center descriptive study

The risk of malignancy development in kidney transplant recipients (KTRs) is 2-3 times higher than in the general population. This picture, which emerged with chronic immunosuppressive use, has become more prominent in recent years as the ongoing cause of death in this population. This study aims to determine the common features of KTRs with malignancy in follow-up under a single-center experience. Thus, it is to save time by correctly determining our focus points in patient follow-up.&#x0D; Methods. The files of 403 patients who underwent kidney transplantation between 2005 and 2020 in our hospital were reviewed retrospectively. The clinical findings at admission were age, gender, primary disease, use of cyclophosphamide before transplant, duration of dialysis, number of human leukocyte antigen mismatch, transplantation time, previous rejection, the existence of associated viral infections, comorbid diseases, used induction therapy, maintenance immunosuppressive therapy, allograft survival, recipient survival, malignancy development time after transplantation, serum creatinine, glomerular filtration rate (GFR) and presence of proteinuria and hematuria. Using these data, we retrospectively analyzed the incidence and types of malignancies in KTRs.&#x0D; Results. During the follow-up period, 22cancer cases have been developed. The median age of the patient was 60 years (IQR 45-64.3) and patients were mostly male (77.3%) The median follow-up period was 111.5 months (IQR76.3–128.3). The median duration of dialysis was 54 months (IQR 11.5-78). The etiology of primary kidney disease in most KTRs recipients was unknown. The percentage of patients with mismatch 3 and above 3 was 86.3%. While the majority of patients received anti-thymocyte globulin (86.4 %) as induction therapy, maintenance therapy was mostly tacrolimus + mycophenolate mofetil + prednisolone (86.4 %). The median time from transplantation to the initial malignancy was 17.5 months (IQR 5-61.3). The most common initial malignancy was skin cancer (22.7%), followed by renal cell carcinoma originating from the native kidney (18.2%).&#x0D; Conclusion. Renal transplantation is the most favorable renal replacement therapy. Malignancies are now among the important causes of death in KTRs and these patients have a higher risk of developing cancer than the general population. Therefore, screening for cancer at certain intervals, especially in long-term and elderly recipients after transplantation, will positively affect the survival of the patient and functional renal graft.

POS-690 Outcomes of Malignancy in Kidney Transplant Recipients

Malignancy, cardiovascular events, and infections are the leading causes of death among kidney transplant (KT) recipients. The risk of cancer in KT recipient is two to 4 folds increased than general population with reported higher mortality rates. Post-transplant malignancies can be related to de novo development, donor-related transmission, and recurrence of a recipient’s pre-transplant malignancy. Common malignancies post kidney transplantation are non-melanotic skin cancer, Kaposi sarcoma, post-transplant lym­phoproliferative disorder (PTLD), renal cell carcinoma (RCC), and anogenital cancer.

The incidence of post-transplant malignancies in kidney transplant recipients treated with Rituximab.

Rituximab has been proposed as induction therapy in kidney transplant recipients (KTRs) with preformed donor-specific antibodies (DSA) or a positive flow cross-match. We here evaluated whether adding rituximab was associated with a higher incidence of post-transplant malignancies (PTM) due to greater immunosuppression. Forty-eight HLA-sensitized KTRs received induction therapy with anti-thymocyte globulin (ATG) and rituximab because of preformed DSA or a positive flow cross-match (RTX group). They were compared with a control group of 154 patients receiving ATG alone. Thirty-nine of 202 (19.3%) patients developed PTM; the rate was similar in the RTX and no-RTX groups (14.6% vs. 20.8%, respectively, P=.3). The distributions of the types of cancer were similar between the two groups, with the majority being non-melanoma skin cancer (NMSC, n=24). The risk factors for PTM were male gender, age, history of cancer, and azathioprine. Our data do not indicate a higher rate of post-transplantation de novo malignancies after kidney transplantation in high-immunological risk patients who received induction therapy based on ATG and rituximab.

Secondary Malignancy in Kidney Transplant Recipients: University of Southern California Experience

Secondary Malignancy in Kidney Transplant Recipients: University of Southern California Experience

De Novo Malignancy After Heart, Kidney, and Liver Transplant: A Nationwide Study in Taiwan.

In the Asian population, patterns and risk factors for de novo malignancies after solid-organ transplant are not well understood. Insurance claims from Taiwan's National Health Institute Research Database from 1997 to 2011 revealed 687 deceased-donor heart transplant recipients, 5038 kidney transplant recipients (50% living related-donor, 50% deceased-donor transplants), and 2127 liver transplant recipients (mainly living related-donor transplants, 30% deceased-donor transplants). During the follow-up period, rates of malignancy incidence were calculated with standardization based on national age, sex, and year-specific incidence. We used multivariate regression analyses to determine risk factors of posttransplant de novo malignancies. Compared with the general population, several de novo cancers were more common posttransplant (P < .05): lung cancer (2.6-fold), non-melanoma skin cancer (5.8-fold), and non-Hodgkin lymphoma (5.4-fold) in heart recipients; transitional cell carcinoma (31.4-fold), renal cell carcinoma (37.3-fold), and non-Hodgkin lymphoma (3.6-fold) in kidney recipients; and gastric cancer (3.0-fold) and lymphatic-hematopoietic malignancy (4.5-fold) in liver recipients. Independent risk factors for posttransplant malignancy in kidney transplant recipients were increased age, female, hepatitis B virus, and mycophenolate use (adjusted hazard ratio 1.5; 95% confidence interval, 1.2-1.8; P < .001). In liver transplant recipients, old age was an independent risk factor. Kidney transplant recipients without diabetes or hypertension had higher risk of transitional cell carcinoma (adjusted hazard ratio 3.0; 95% confidence interval, 2.1-4.4; P < .001) and renal cell carcinoma (adjusted hazard ratio 1.9; 95% confidence interval, 1.1-3.3; P < .05). Regional endemic epidemiologic factors play significant roles in the development of de novo cancers, particularly in kidney transplant recipients due to causes of renal failure other than diabetes and hypertension. Each regional organ transplant program should tailor and establish its surveillance protocol based on epidemiologic data. However, the type and intensity of surveillance require further and long-term investigations in this patient cohort.

SAT-358 THE INCIDENCE OF MALIGNANCY AND ITS RELATED FACTORS IN PATIENTS UNDERGOING KIDNEY TRANSPLANTATION

Renal transplantation is considered as the treatment of choice for patients with ESRD. The underlying causes of death among renal transplant recipients have changed from early immunologic and nonimmunological failure to cardiovascular disease and malignancy. In this study we evaluated the incidence of malignancy and its related factors in renal transplant patients in Razi Hospital of Rasht over a period of 10 years. In this retrospective study, 549 patients who underwent renal transplantation surgery in Razi Hospital between 2008 and 2019 were studied. Demographic and clinical characteristics of patients and other required information were recorded in a checklist. Required patient information was obtained from the case of pre and post-transplant and outpatient follow-up. In this study, it was found that only the patient's age at the time of renal transplantation in recipients of intervention has a confounding and additive role in incidence of malignancy after transplantation (P=0.0001). It was also found that there was no statistically significant relationship between sex of patients, current smoking status, smoking history, family history of malignancy, number of transplants, post-transplant survival, sun exposure, transplant rejection history, patient follow-up, occupational status, the use of daclizumab (Zenapax ATG) induction and incidence of malignancy after kidney transplantation. Estimates of standardized incidence ratio showed that the incidence of malignancy in kidney transplant recipients was 26.9 higher than the incidence rate in Guilan province and 21.7 higher than the incidence of malignancy in the country. The incidence rate of cancer in kidney transplant patients is 26.9 times higher than Guilan province rate (95% CI: 19.7-35.9) and 21.7 times higher than national rate (95% CI: 15.9-28.9). In this study, the incidence rate of cancer is 792 per 100000-person year. In this study, it was found that only the patient's age at the time of kidney transplantation has a confounding and increasing role in the incidence of post-transplant malignancy. It has also been shown that the most common malignancy in these patients is non-melanoma skin malignancy and Kaposi's sarcoma comes in second.

Changing pattern and safety of pretransplant malignancy in kidney transplant recipients.

BackgroundCancer rates are increasing not only in the general population but also in patients with end-stage renal disease. We investigated the changing pattern of pretransplant malignancy in kidney transplant recipients over 5 decades.MethodsWe reviewed 3,748 kidney transplant recipients between 1969 and 2016. We divided patients into three groups (1969–1998, 1999–2006, 2007–2016) based on the era of the cancer screening system used throughout the nation. We analyzed the incidence and pattern of pretransplant malignancy among the three groups. We also evaluated recurrent and de novo malignancy in these patients compared to patients without pretransplant malignancy.ResultsA total of 72 patients exhibited pretransplant malignancy (1.9%). There were no cases of pretransplant cancer until 1998, but the rate of pretransplant malignancy gradually increased to 1.1% during 1999–2006 and further increased to 4.3% thereafter. The most frequent types of pretransplant malignancy changed from the bladder, liver, and stomach cancers to thyroid cancer and renal cell carcinoma. There were no de novo cases, but there were three cases of recurrent cancer in patients with pretransplant malignancy; the recurrence rate among kidney transplant recipients with pretransplant malignancy was not significantly different from the incidence rate of de novo malignancy among kidney transplant recipients without pretransplant malignancy (4.2% vs. 6.9%, P = 0.48).ConclusionThe incidence of pretransplant malignancy in kidney transplantation candidates is gradually increasing, and recent increases were accompanied by changes in cancer types. Pretransplant malignancy may not be a hindrance to kidney transplantation because of the low incidence of posttransplant recurrence and de novo malignancy.

Prostate Cancer Recurrence in Kidney Transplant Recipient 15 Years After Radical Prostatectomy: A Case Report

Incidence of malignant tumors in kidney transplant recipients is higher than nontransplanted population due to many factors, such as immunosuppression therapy and complex donor-recipient interaction. Genitourinary malignancies have been reported as the second most common malignancy in kidney transplant recipients. In this regard, prostate cancer is the most common neoplasm. Herein, we describe a rare case of prostate cancer recurrence after 15 years in a patient who underwent kidney transplant after radical prostatectomy.