Urological malignancy as a complication of renal transplantation: Report of 9 clinical cases

Abstract

Objective

To analyze the epidemiographic features of urological malignancy in renal allograft recipients (RAR) in a single center.

Methods

A retrospective analysis was made on 2300 patients who received renal allografts from June 1978 to December 2001 and anti-rejection treatment for at least 3 months.

Results

Of the 2300 recipients, 27 (1.22%) developed malignancies, including 9 patients (0.39%), 6 males and 3 females) with urological tumors and 18 patients with skin carcinoma, right liver lobular cystic adenocarcinoma, hepatocellular carcinoma, gastric cancer, colorectal carcinoma, ileocecal adenoma, lip cancer, and pulmonary lymphoma and breast cancer. The 9 cases of urological malignancies included one case of renal cell carcinoma, 2 cases of bilateral pelvic transitional cell carcinoma (TCC), 3 cases of unilateral pelvic TCC, one case of ureter TCC and 2 cases of bladder TCC. The age at which the diagnosis was made ranged from 49 to 63 years with a mean of 57.5±5.6 years, and the mean course of immunosuppressive therapy ranged from 36 to 94 months with a mean of 58±18 months. Of the 9 patients who developed urological malignancies, 6 had been on a Cyclosporine A + Azalthioprine + Prednisone (CsA + Aza + Pred) protocol, and 3 on a Cyclosporine A + Mycophenolate Mofetil + Prednisone (CsA + MMF + Pred) protocol. One of the 9 patients died soon after the diagnosis was made, and the remaining 8 patients received surgical resection. Of them, 8 patients survived well and the other one died from cerebral hemorrhage soon after operation.

Conclusion

Urological malignancies, especially TCC, is an important complication in renal transplanatation found in this center. The incidence of urological malignancy in RAR is about 10 times that in the general population of Shanghai versus 2 times for other malignancies. Pelvic TCC is the No. one malignancy and bladder TCC the second in RAR. The occurrence of the malignancies in RAR seems to be closely related to the use of immunosuppressive agents. Immunosuppression results in the weakening of immnuologic surveillance function, leading to mutation, aberration and carcinogenesis. The immunological status of patients after renal transplantation should be assessed regularly. Painless macroscopic hematuria should be considered a significant sign in assessing the potential occurrence of urological malignancy in RAR. Treatment includes early diagnosis, timely surgical resection and reduction of immunosuprressive agents.