malignancy is a recognized complication of renal transplantation . in australia , it is estimated that 25% of all renal transplant recipients surviving for 20 years will develop a non - skin cancer . renal cell carcinoma ( rcc ) accounted for 4.6% of de novo cancer in solid organ transplant recipients , but the majority occurred in native kidneys and less than 10% in allograft kidneys . a number of case reports have been published on partial nephrectomy as a treatment option particularly when the rcc is less than 4 cm [ 36 ] . we report a case of rcc in a kidney allograft compromised by previous segmental infarction and chronic allograft nephropathy ( can ) , which was treated successfully with nephron - sparing partial nephrectomy . a 47-year - old woman with end - stage renal disease due to reflux nephropathy underwent deceased donor renal transplantation in 1994 . sirolimus was changed to tacrolimus 2 years later due to heavy proteinuria ( 4.5 g / day ) . eleven years after transplantation , a 3.3 cm mass was found in the lower pole of the renal allograft during transabdominal ultrasound for investigation of pelvic pain . magnetic resonance imaging confirmed the presence of a complex cystic mass that was highly suspicious for a rcc . there was no radiological evidence of local and distant metastases or involvement of the native kidneys . at that time post - surgery , she developed acute tubular necrosis of the allograft and required three haemodialysis sessions . she subsequently made an uneventful recovery with serum creatinine 272 mol / l on discharge . three years after surgery , there is no evidence of rcc recurrence and she remains free of renal replacement therapy . traditionally , the treatment for rcc arising from kidney allografts has been allograft nephrectomy , withdrawal of immunosuppressive therapy and resumption of dialysis . however , recent data suggest that partial nephrectomy is emerging as a viable alternative option . butler et al . reported that radical nephrectomy and partial nephrectomy provided equally effective treatment for single , localized rcc of less than 4 cm in native kidneys . one long - term follow - up study has found the cancer - specific survival to be 100% at 10 years in patients who underwent partial nephrectomy with tumours less than 4 cm . rcc involving transplant recipients appear to have similar biological behaviour as those involving patients without immunosuppression . as a result , the use of partial nephrectomy has been extrapolated into the management of rcc in kidney allografts . there were 18 cases of tumour in renal allografts treated by partial nephrectomy reported in the worldwide literature . of these cases , 13 ( 81% ) had rcc , 2 had oncocytoma , 1 had angiomyolipoma and the pathology was not reported in 2 cases . of the rcc cases , 11 cases ( 85% ) were small lesions measuring less than 4 cm while one was 6 cm and the other 9 cm . mean time of diagnosis after transplantation was 11.1 years ( range : 1 month to 21.5 years ) . in this series , mean follow - up after partial allograft nephrectomy was 32 months ( range : 0.5138 months ) with no patient reported to develop local recurrence , renal failure or distant dissemination . although the data are limited , the evidence so far indicates that nephron - sparing surgery provides a durable cancer control of tumours less than 4 cm without significant compromise to graft function . therefore , partial graft nephrectomy may be proposed as the treatment of choice for tumours less than 4 cm . this would avoid returning patients to dialysis that is associated with inferior life expectancy and quality of life when compared with a functioning graft . moreover , partial graft nephrectomy avoids overtreatment of unexpected non - malignant tumours . in the majority of previous cases , partial graft nephrectomy was performed on good functioning allograft with serum creatinine between 79 and 158 mol / l . however , in the case described , the graft function is compromised because of segmental infarction and can . partial graft nephrectomy in allograft kidneys with severe compromised function has only been reported in two previous cases , one with creatinine of 211 mol / l and 222 mol / l in the other . graft function in these two cases was still preserved after 6 and 22 months , respectively . to our knowledge , the described case is the first to have undergone successful partial allograft nephrectomy in the setting of segmental infarction . it is performed in a non - nave surgical field where severe inflammation and scarring are usually present , making kidney mobilization , pedicle control and parenchymal resection often difficult . the continuous perfusion of the allograft with the cooled ross solution preserved the residual kidney function , as seen in the merkel 's case   and the current case . this continuous perfusion also made it easier to identify and individually ligate all vessels in the cut surface to minimize blood loss . intra - operative ultrasound can assist in gaining satisfactory clearance and preserve renal parenchyma for optimal renal function . it also allowed exact determination of the extent of these lesions if polycentricity is present . rcc arising from a renal allograft is rare . data are accumulating to suggest that preservation of renal function can be achieved by partial nephrectomy without sacrificing control of the malignancy .