Abstract
Kidney recipients are at increased risk for developing malignancies after transplant due to its association with prolonged use of immunosuppression. Patients with hematuria after kidney transplantation can present with urothelial cell carcinoma (UCC) of the allograft. This report describes a 67-year old female who presented with UCC of her first living donor kidney allograft of 42 years immediately after a repeat deceased donor kidney transplant. This patient's case provides a unique presentation and diagnostic challenges of UCC involving a prior failed kidney allograft in a patient early after repeat transplantation. Diagnostic approaches including tagged red blood cell scan and formal cystoscopy with ureteral sampling are discussed. In this case, multimodality diagnostics were necessary for determining the correct therapeutic approach.