# Management of high-grade ovarian adenocarcinoma in an intraperitoneal pelvic renal transplant recipient

## TL;DR

This paper presents a case of ovarian cancer managed successfully in a kidney transplant recipient, emphasizing the need for a multidisciplinary approach to balance cancer treatment and organ function.

## Contribution

A detailed case study demonstrating effective cancer management in a renal transplant recipient while preserving graft function.

## Key findings

- Surgical staging and chemotherapy were performed successfully without compromising renal graft function.
- Recurrence was effectively managed with secondary tumor debulking and pelvic radiation.
- Multidisciplinary care is essential for optimizing outcomes in transplant patients with gynecologic cancers.

## Abstract

•Immunosuppressive therapy complicates cancer management in transplant patients.•Surgical staging and adjuvant chemotherapy were successfully performed while maintaining renal graft function.•Recurrence was managed with secondary tumor debulking and pelvic radiation.•A multidisciplinary approach is essential for optimizing both oncologic and transplant outcomes.•Further research is necessary to guide management strategies for gynecologic cancers in transplant patients.

Immunosuppressive therapy complicates cancer management in transplant patients.

Surgical staging and adjuvant chemotherapy were successfully performed while maintaining renal graft function.

Recurrence was managed with secondary tumor debulking and pelvic radiation.

A multidisciplinary approach is essential for optimizing both oncologic and transplant outcomes.

Further research is necessary to guide management strategies for gynecologic cancers in transplant patients.

The increasing number of organ transplant recipients has led to a rise in cancer diagnoses in this population. Kidney transplant recipients, in particular, have a two-to-four-fold higher risk of developing cancer due to immunosuppressive therapy. The management of gynecologic cancers in this subset of patients presents unique challenges due to anatomical considerations, immunosuppression, and the nephrotoxicity of oncologic treatments.

Case Presentation.

A 44-year-old woman with a history of polycystic kidney disease underwent a bilateral nephrectomy followed by a living-related intraperitoneal renal transplant. She presented with pelvic pain and was found to have high-grade ovarian adenocarcinoma, possibly arising from endometriosis. Surgical staging included total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and right pelvic lymph node dissection. The patient underwent six cycles of carboplatin and paclitaxel chemotherapy while maintaining stable renal function with close monitoring of immunosuppressive drug levels. Surveillance imaging detected recurrence in the right pelvic lymph nodes, leading to secondary tumor debulking and whole pelvic radiation therapy. Despite a slight increase in creatinine, kidney function remained stable, and the patient has remained disease-free on subsequent follow-ups.

The management of ovarian cancer in kidney transplant recipients requires a multidisciplinary approach to balance oncologic control with graft preservation. Close monitoring of renal function, careful surgical planning, and tailored chemotherapy and radiation strategies are critical. More research is needed to establish standardized guidelines for managing gynecologic malignancies in transplant patients.