Abstract
Objective
To summarize the diagnosis, surgical intervention and postoperative management of patients with urothelial cancer (UC) after renal transplants (RTx).
Methods
In our retrospective review of 3,370 RTx recipients in our transplant center from 1974 to 2012, all recipients underwent routine checkups and follow-up. Imaging was performed in all patients suspected of having malignancies, and the histological cell type of the specimen slices was reappraised by pathologists. The data of all recipients with malignancies were retrospectively reviewed to determine clinical characteristics after RTx.
Results
A total of 169 patients of the cohort of 3,370 had malignancies after RTx. Of 180 tumors, 106 tumors were confirmed as UC. Fifty-two patients had taken drugs containing aristolochic acid. The median time to neoplasia after RTx in the group taking aristolochic acid (30 months) was significantly less than in those not taking aristolochic acid (60.3 months). We recommended surgical intervention for RTx recipients with UC, transurethral resection of bladder tumors for patients with solitary or concomitant superficial UC, and radical cystectomy for high-risk bladder UC. We performed simultaneous bilateral or unilateral nephroureterectomy in patients with upper urinary tract UC.
Conclusion
Our results suggest that UC is the predominant tumor in Chinese RTx recipients and that regular urinalysis and imaging are needed in all recipients after RTx, especially women with a history of taking aristolochic acid. Surgical interventions did not increase the risk beyond that in UC patients without RTx.
Similar content being viewed by others
References
La Manna G, Corsini S, Iannelli S, Cappuccilli ML, Comai G, Iorio M, Todeschini P, Carretta E, Scolari MP, Bontadini A, Stefoni S (2013) Influence of the immunogenetic KIR and HLA systems on long-term renal transplant outcome. Ann Transpl 18:611–621
Villeneuve PJ, Schaubel DE, Fenton SS, Shepherd FA, Jiang Y, Mao Y (2007) Cancer incidence among Canadian kidney transplant recipients. Am J Transpl 7(4):941–948
Sheil AG, Disney AP, Mathew TH, Livingston BE, Keogh AM (1997) Lymphoma incidence, cyclosporine, and the evolution and major impact of malignancy following organ transplantation. Transpl Proc 29(1–2):825–827
Birkeland SA, Storm HH, Lamm LU, Barlow L, Blohmé I, Forsberg B, Eklund B, Fjeldborg O, Friedberg M, Frödin L (1995) Cancer risk after renal transplantation in the Nordic countries, 1964-1986. Int J Cancer 60(2):183–189
Penn I (1994) Malignancy. Surg Clin North Am 74(5):1247–1257
Penn I (2000) Cancers in renal transplant recipients. Adv Ren Replace Ther 7(2):147–156
Vogt P, Frei U, Repp H, Bunzendahl H, Oldhafer K, Pichlmayr R (1990) Malignant tumor in renal transplant recipients receiving cyclosporine: survey of 598 first-kidney transplantation. Nephrol Dial Transplant 5(4):282–288
Ochiai T, Asano T, Isono K (1987) Development of malignancies in Japanese renal transplant recipients. Transplant Proc 19(2):2967–2970
Buzzeo BD, Heisey DM, Messing EM (1997) Bladder cancer in renal transplant recipients. Urology 50(4):525–528
Feng WW, Wang TN, Chen HC, Ho JC, Ko YC (2007) Malignancies after renal transplantation in southern Taiwan: experience in one centre. BJU Int 99(4):825–829
Wu MJ, Lian JD, Yang CR, Cheng CH, Chen CH, Lee WC, Shu KH, Tang MJ (2004) High cumulative incidence of urinary tract urothelial cancer after kidney transplantation in Taiwan. Am J Kidney Dis 43(6):1091–1097
Li XB, Xing NZ, Wang Y, Hu XP, Yin H, Zhang XD (2008) Transitional cell carcinoma in renal transplant recipients: a single center experience. Int J Urol 15(1):53–57
Melchior S, Franzaring L, Shardan A, Schwenke C, Plümpe A, Schnell R, Dreikorn K (2011) Urological de novo malignancy after kidney transplantation: a case for the urologist. J Urol 185(2):428–432
Penn I (1987) Cancer following cyclosporine therapy. Transplantation 43(1):32–35
Galve ML, Cuervas-Mons V, Figueras J, Herrero I, Mata M, Clemente G, Prieto M, Margarit C, Bernardos A, Casafont F (1999) Incidence and outcome of de novo malignancies after liver transplantation. Transplant Proc 31(1–2):1275–1277
Yokota K, Fukumitsu M, Kuzuhara K, Otsubo O, Tomikawa S, Nagao T, Uchida H, Sato K, Nakayama Y, Endo T (1994) Development of cancer in renal allograft recipients. Transplant Proc 26(4):1977–1978
Jin DC, Yoon YS, Yoou SA (1994) Ten cases of malignancies in kidney allograft. Transpl Proc 26(4):1975–1978
Rogers A, Ng JK, Glendinning J, Rix D (2012) The management of transitional cell carcinoma (TCC) in a European regional renal transplant population. BJU Int 110(2 Pt B):E34–E40
Liao CH, Chueh SC, Lai MK, Chen J (2004) Transitional cell carcinoma in renal transplant recipients. Transpl Proc 36(7):2152–2153
Kao YL, Ou YC, Yang CR, Ho HC, Su CK, Shu KH (2003) Transitional cell carcinoma in renal transplant recipients. World J Surg 27(8):912–916
Yuan M, Shi YB, Li ZH, Xia M, Ji GZ, Xu GX, Han Y (2009) De novo urothelial carcinoma in kidney transplant patients with end-stage aristolochic acid nephropathy in China. Transpl Proc 41(5):1619–1623
Stiborová M, Frei E, Hodek P, Wiessler M, Schmeiser HH (2005) Human hepatic and renal microsomes, cytochromes P450 1A1/2, NADPH:cytochrome P450 reductase and prostaglandin H synthase mediate the formation of aristolochic acid-DNA adducts found in patients with urothelial cancer. Int J Cancer 113(2):189–197
Stiborová M, Frei E, Schmeiser HH, Arlt VM, Martínek V (2014) Mechanisms of enzyme-catalyzed reduction of two carcinogenic nitro-aromatics, 3-nitrobenzanthrone and aristolochic acid I: experimental and theoretical approaches. Int J Mol Sci 15(6):10271–10295
Hou HJ, Xiao J, Tian Y (2013) Contralateral nephroureterectomy for renal transplant recipients with unilateral upper urinary tract transitional cell carcinoma: a report of 12 cases. Transplant Proc 45(6):2203–2206
Javaid MM, Chowdhury S, Henderson A, Olsburgh J (2013) Advanced native kidney renal cell carcinoma in renal transplant recipients: role of sirolimus as dual anti-cancer and anti-rejection agent. Clin Nephrol 79(2):154–160
Chamie K, Litwin MS, Bassett JC, Daskivich TJ, Lai J, Hanley JM, Konety BR, Saigal CS (2013) Recurrence of high-risk bladder cancer: a population-based analysis. Cancer 119(17):3219–3227
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zhang, A., Shang, D., Zhang, J. et al. A retrospective review of patients with urothelial cancer in 3,370 recipients after renal transplantation: a single-center experience. World J Urol 33, 713–717 (2015). https://doi.org/10.1007/s00345-014-1412-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-014-1412-4