Treatment options for renal cell carcinoma (RCC) in a renal allograft include radical nephrectomy or nephron-sparing surgery (NSS). We report the case of local recurrence of an RCC in kidney allograft. Five years after previously undergoing NSS, a recurrent lesion was diagnosed in the upper pole of the kidney graft in a 74-year-old patient during routine duplex ultrasonography. The computerized tomography image showed a spherical lesion of 24 mm in diameter. The patient was free of clinical symptoms and additional staging examinations showed no signs of metastatic spread. Considering the poor function of the kidney allograft with the need for dialysis, a removal of the graft was performed without peri- and postoperative adverse events. The final pathology revealed recurrence of a clear-cell adenocarcinoma of the kidney allograft (pT1a, G1). The patient had an uneventful recovery and was discharged from the hospital after 6 days. During the last follow-up, the patient remained stable on hemodialysis and reported good overall health condition. In conclusion, patients after NSS for small renal masses in kidney allograft should remain under careful observation in order to detect early local recurrence.
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