WCN26-4338 Acute Tubular Injury With Vacuolization After Palbociclib Exposure in a Patient With Advanced Breast Cancer

and their own chances of developing another kidney cancer in the remaining kidney.To answer these question, we did a thorough literature search and found that Cristea et al have analysed 30 data sets showing that a total of 147 tumorectomized kidneys have been transplanted so far.Most excised tumors were RCC (81%), mean tumor size was 2 cm and nucleolar/Fuhrman grade I-II (93%) with mean followup of 39.9 months.Only 1 local tumor recurrence occurred in a patient 9 years after transplantation, demonstrating a recurrence rate of 1.4% in the recipients.The 5-year patient and graft survival were 92% and 95.6%, respectively.Based on the available data, various governing bodies recommend that donor kidney can be used for transplantation after excision of RCC (clear-cell type) if size <2-4 cm, nucleolar grade #II with clear surgical margins.In a recent report of 28,556 Scandinavian patients with RCC, the 20-year cumulative incidence of metachronous RCC was 0.8%.Using the US SEER database the incidence of metachronous RCC among 43,483 patients was 0.4% up to 10 years.This knowledge enabled us to provide sufficient evidence to the recipient and donor of their lower chances of tumor recurrence and good graft function by accepting the tumorectemized kidney.With the institutional ethics committee at the helm of affairs, we conducted several counselling and consenting session at appropriate stages to clearly outline the risk of cancer recurrence and transmission, the surgical complications and the need for ongoing post-transplant surveillance for RCC recurrence, in addition to the standard posttransplant follow-up.Only after confirming the willingness from the donor and recipient separately, the decision to proceed with the transplantation was made.Concurring with the recommendations and robust evidence from available literature, we were able to carry out the renal transplantation.We used the contemporary immunosuppression in the kidney transplant recipient consisting of a calcineurin inhibitor (CNI), an antiproliferative agent(MMF) and a systemic corticosteroid since there are no definitive guidelines for use of mTOR inhibitors in reducing the risk of RCC recurrence.The recommendation for follow-up suggest a conservative approach, comprising of ultrasound, chest x-ray, abdominal CT and laboratory investigations (complete blood count, renal function test, liver function test and calcium).In line with this, our follow-up data is limited to 3 months post transplantation.Both the recipient and donor are doing well with normal renal functions and no evidence of recurrence by the imaging studies.Conclusion: Currently, the overall number of kidneys transplanted after excision of primary renal tumours is small.However in future, elderly population with co-morbidities including malignancies, coming forward as potential organ donors will only increase.It is now evident that kidneys with Small Renal Mass should not be a hindrance for transplantation.In the clinical and ethical context, this case posed a unique situation bringing out the complexity in decision making and proceeding with the renal transplantation.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.