Tumor Origin of the Graft Ureteral Cancer: From Recipient or Donor?
Jia-Yuh Sheu4, Fang-Yu Cha1, Chao-Yuan Huang1, Yu-Chieh Tsai2, Hsiao-Lin Hwa3, Jeff S Chueh1
Department of Urology1, Oncology2, Medical Genetics3, and Medical Education4, National Taiwan University Hospital, Taipei, Taiwan
Purpose: To demonstrate that we can distinguish the origin of cancer in the graft ureter as recipient- or donor-derived by using the short tandem repeats (STRs) while the recipient and donor are of the same gender.
Materials and Methods: A 30-year-old Taiwanese woman had received a kidney transplant from her aunt 22 years ago. She was diagnosed with high-grade urothelial carcinoma (UC) of the left renal pelvis and ureter ten years later. She underwent the left nephroureterectomy with bladder cuff resection. During follow-up, we discovered her right native ureter and graft ureter tumors. She and her family insisted on the wish to preserve her graft kidney function. Laparoscopic right nephroureterectomy and segmental graft ureterectomy, with bladder cuff resection and Boari flap creation, were performed accordingly. The final pathology report disclosed high-grade invasive UC. In order to distinguish the origin of the graft ureteral cancer, we collected the tumor specimen, the patient's buccal mucosa, and her aunt's blood for STRs analysis by polymerase chain reaction amplification.
Results: The STRs analysis is underway, and relevant results will be presented at Taiwan Urological Association (TUA) annual meeting.
Conclusions: Genetic analysis can differentiate the tumor origin of the transplanted organ, which may further help access the prognosis and the subsequent treatment plan. However, we cannot simply compare sex chromosomes to achieve this goal for the same-sex recipient and donor. The STRs analysis can provide a useful alternative method under such conditions.