Donor-Transmitted Metastatic Prostate Cancer in a Renal Transplant Recipient: A Case Report

Donor-transmitted malignancy is a rare but potentially life-threatening complication of solid organ transplantation. 1 Transmission of prostate cancer is exceedingly uncommon, with only two previously reported cases involving heart and liver recipients. 2,3 We describe the first suspected case in a kidney transplant recipient. A 54-year-old man with type 1 diabetes mellitus and end-stage kidney disease underwent deceased-donor kidney transplantation from a donor without known prostate cancer. Four months after transplantation, serum prostate-specific antigen (PSA) rose from a pre-transplant baseline of 1.36 ng/mL to 6.83 ng/mL following notification that the lung co-recipient from the same donor had developed an elevated PSA. One month later, re-examination of the donor lung procurement biopsy demonstrated intravascular prostate adenocarcinoma. Despite comprehensive evaluation—including prostate magnetic resonance imaging, serial positron emission tomography/computed tomography (PET/CT), prostate-specific membrane antigen (PSMA)-PET/CT, systematic prostate biopsy, and whole-body imaging—all studies remained negative while PSA increased exponentially to 544 ng/mL. At 14 months post-transplant, hospitalization for acute kidney injury revealed retroperitoneal lymphadenopathy and hydronephrosis suspicious for ureteral obstruction by metastatic disease. Periaortic lymph node biopsy confirmed metastatic prostate adenocarcinoma. This case illustrates the diagnostic challenges of donor-transmitted prostate cancer, which may present with isolated, rapidly rising PSA in the absence of detectable disease on advanced imaging, including PSMA-PET/CT. These observations underscore the importance of robust communication through organ procurement organizations and the need for heightened clinical suspicion when unexplained PSA elevation occurs after transplantation.