The risk of genitourinary cancers following transplantation is increased following majority of solid organ transplants but is best described following renal transplantation. Increasing average age of the transplant recipient as well as increases in post- transplant survival increases the risk of these malignancies. The risk of Kidney cancer is the highest following most solid organ transplants, whereas prostate cancer risk is lower than the general population in multiple large population-based studies. The etiology of increased risk of cancer following transplant is multifactorial with the predominant influence of immunosuppression and direct toxicity of immunosuppressants, however, the significance of end stage disease particularly in the causation of renal cancer in renal transplant recipients is undeniable. Modifications in immunosuppression regimens as well as changes in the standard treatment principles of some cancers may require changes in the management of some post-transplant malignancies. Standard screening guidelines have not been established but screening for renal tumors in renal transplant recipients is the only widely studied entity. Further work is needed to prepare the urologic oncological community with this once rare population group and standardized recommendations need to be established for screening and for the use of new age cancer therapeutics like immunotherapy.

Background: Living donor renal transplant with grafts having complex vascular anatomy is technically difficult with higher complications. We herein present our experience of complex vascular anatomy living donor renal grafts as compared to grafts with simple vascular anatomy. Methods:The is a retrospective comparative analysis of a prospectively maintained database of all the patients undergoing live related renal allograft transplant from January 2015 till Dec 2019. All adult transplants with graft with complex vascular anatomy were included and deceased donor and pediatric transplants were excluded.Results: There were 422 eligible transplant patients out of which 92 (21.8%) patients had grafts with complex vascular anatomy and 330 (78.2%) patients had single renal artery and vein. There were no major intra-operative complications. Warm ischemia time and operating time were significantly less in single artery group (p < 0.001). There was no difference in terms of urine output, fall in serum creatinine levels, delayed graft function (4.2% vs. 4.3%), primary graft non function (1% vs. 0.6%), urine leak (2.1% vs. 3%) and hospital stay. Conclusion:Renal transplant with grafts with multiple renal vessels have equivalent outcomes as compared to simple vascular anatomy. Complex vascular anatomy living donor transplants should be done in high volume centers by experienced surgeons.