Kidney Graft Urothelial Carcinoma: Results From a Multicentric Retrospective National Study

Transplant Radical Nephrectomy and Transplant Radical Nephroureterectomy for Renal Cancer: Postoperative and Survival Outcomes

“…While the existing literature supports nephron-sparing surgery, when indicated, to preserve renal allograft function and avoid dialysis, limited data informs clinicians regarding outcomes of transplant radical nephrectomy or nephroureterectomy in patients with either an already failed allograft or, when nephron-sparing surgery is not feasible, because of the complexity of the cancer, determined by the tumor size, location, grade and multifocality [ 5 , 32 – 34 ]. Transplant radical nephrectomy with the excision of the ureter and bladder cuff is the optimal approach for patients with UCC, regardless of the tumor size, location, or feasibility of nephron-sparing surgery [ 8 – 10 , 35 , 36 ]. In our cohort, 7 patients had failed transplants and were on dialysis, and 3 had tumors not suitable for nephron-sparing surgery.…”

“…Development of RCC is more common in the native kidney compared to the allografts [ 2 – 7 ]. UCC arises from the urothelium of the collecting system and can be seen in the kidney (minor and major calyxes and renal pelvis), ureter, or both [ 8 – 10 ]. For UCC tumors, transplant radical nephroureterectomy, and for RCC tumors, transplant radical nephrectomy, are considered the standards of care for patients with failed allografts on dialysis or patients who are not candidates for nephron-sparing surgery.…”

Urological Cancers and Kidney Transplantation: a Literature Review

“…Risk factors that have been identified for developing UC in RTRs are prior treatments with immunosuppressive agents, cyclophosphamide, BK virus nephropathy, analgesic nephropathy, tobacco, occupational exposure, and aristolochic acid (AA) use (a Chinese herbal product employed for the treatment of digestive, chronic renal, inflammatory, and infectious diseases) [49]. Several mechanisms of immunosuppressive medication have been suggested as oncogenic; for example, MMF has been associated with elevated blood arsenic levels (carcinogen of group 1 associated to BC) and decreased levels of selenium in erythrocytes [50].…”

“…The mean time to develop UC after renal transplant ranges from 5.2 to 9.5 years [48,56,57,[59][60][61] with urothelial histology being present in 93% of the patients, while squamous and adenocarcinoma differentiation reach 3.4% each [61]. Hematuria is the most frequent clinical presentation (36.4-42.5%) [49,61,62]; however, some studies report incidental diagnosis in up to 50% of RTRs [61,62].…”

“…If graft UC is diagnosed prompting for graft nephroureterectomy, the time in which another KT can be performed has not been clearly established; however, waiting for 2 years in low-grade upper tract UC and 5 years for high-grade upper tract UC is advised [49].…”