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Urologische Nachsorge und Entwicklung von Malignomen nach Nierentransplantation

Urological follow-up and development of cancer after renal transplantation

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Zusammenfassung

Hintergrund

Die Anzahl an Patienten mit einem funktionierenden Nierentransplantat steigt, ebenso steigt die Transplantat- und Empfängerüberlebensdauer. Die Sicherstellung der Urinableitung nach Nierentransplantation (NTX) sowie das Erkennen und die Behandlung urologischer benigner und maligner Erkrankungen gewinnt zunehmend an Bedeutung. Insbesondere vor dem Hintergrund, dass urologische Neoplasien zu den häufigsten malignen Erkrankungen nach NTX zählen, ist eine intensive urologische Nachsorge Bestandteil der regelmäßigen Kontrolluntersuchungen nach NTX.

Empfehlungen

Die Nachsorge nach NTX muss die Sicherstellung des Harnabflusses zum Ziel haben und Harnleiterstrikturen, relevanten Reflux sowie eine Blasenentleerungsstörung [z. B. neurogene Ursache, benigne Prostatahyperplasie (BPH) etc.] ausschließen oder einer Therapie zuzuführen. Harnwegsinfekte (HWI) können bei Transplantatempfängern lebensbedrohlich sein und müssen erregergerecht konsequent langfristig behandelt werden. Eine Prophylaxe ist bei symptomatischen rezidivierenden HWI ebenso sinnvoll wie eine sich unmittelbar an die Transplantation anschließende Langzeit-HWI-Prophylaxe über mindestens 6 Monate. Asymptomatische Bakteriurien sind nicht zwingend behandlungsbedürftig. Urologische Malignome wie das Nierenzellkarzinom der Eigennieren, das Urothel- und Peniskarzinom treten vermehrt nach NTX auf, Hodentumoren und Prostatakarzinome haben keine erhöhte Inzidenz. Die operativen bzw. medikamentösen Behandlungsoptionen urologischer Karzinome unterscheiden sich nicht von der Normalpopulation. Ob und wie die Immunsuppression umgestellt oder adaptiert werden muss entscheidet sich auf Grundlage der individuellen Empfängersituation.

Abstract

Background

The number of renal transplant recipients is rising, as well as graft and recipient survival. The mainstay of urological follow-up is to ensure urine transport and voiding function; also, the diagnosis and treatment of urological malignancies following renal transplantats is growing in importance. As urological malignancies are one of the three most common tumors following renal transplantation (RT), meticulous and regular urological evaluation is a central part of follow-up care after RT.

Recommendations

Urological evaluation following RT must ensure correct urine transport and voiding function. Transplant ureter strictures, relevant ureteral reflux and voiding dysfuntion (e.g., neurologic dysfunction, benign prostate hypeplasia) must be excluded or treated. Urinary tract infection (UTI), which can be life threatening in the immunosuppressed transplant recipient, must be diagnosed and treated consequently and for an adequate period of time. Prophylaxis of UTIs is indicated in patients with recurrent symptomatic UTI as well as in the initial 6 months following renal transplantation. Asymptomatic bacteriuria must not necessarily be treated. The incidence of urological malignancies like renal cell carcinoma, urothelial cancer of the bladder, and penile carcinoma is increased following RT, while the incidence of prostate and testis cancer is the same as in the nontransplant population. Surgical and nonsurgical treatment options do not differ from the normal population. Adaptation, cessation, or switching of the immunosuppressive regimen in case of urologic malignancy must be decided on the individual recipient basis.

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Danksagung

Mein Dank gilt Prof. Dr. Kurt Dreikorn, Bremen, für die Hilfe beim Erstellen des Manuskripts.

Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Giessing gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Universitätsklinik für Urologie, Heinrich Heine-Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    M. Giessing FEBU

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Correspondence to M. Giessing FEBU.

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Giessing, M. Urologische Nachsorge und Entwicklung von Malignomen nach Nierentransplantation. Urologe 54, 1393–1401 (2015). https://doi.org/10.1007/s00120-015-3910-4

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