Urothelial cancer in patients with Endemic Balkan Nephropathy (EN) after renal transplantation.
OBJECTIVE
Analysis of the incidence of urothelial cancer and outcome of treatment in patients with Endemic Balkan Nephropathy (EN) after renal transplantation.


METHODS
From January 1985 until October 2006, 550 kidney transplantations (389 cadaveric) and 5 combined kidney and pancreas transplantations were performed in University Hospital Center Rijeka. In only 6 (1.1%) of 555 transplant recipients, EN was diagnosed as the original kidney disease, based on medical history, clinical findings, and laboratory results, but without pathohistologic verification. All patients with EN received the first renal transplant from a cadaver. Patients' mean age at transplantation was 50.3 +/-15.9 yrs, five patients (83.3%) were male. The incidence of malignant tumors in all 555 transplant recipients was analyzed, with an emphasis on the incidence of urothelial cancer and outcome of treatment in the group of patients with EN.


RESULTS
During posttransplant follow-up period, malignancy was diagnosed in 27 (4.9%) out of 555 transplant recipients. Skin cancer was diagnosed in 7 patients (1.3%), followed by cancer of the urinary tract in 6 patients (1.1%) and breast cancer in 3 patients (0.5%). In 3 of 6 patients with EN, urothelial cancer was diagnosed, resulting in the death in two patients. In the third patient, urothelial cancer showed a high affinity for recurrence, and besides the strong reduction of immunosuppressive therapy, repeated surgical treatment was needed.


CONCLUSIONS
Patients with EN show a high incidence of urothelial cancer after renal transplantation. A thorough nephro-urological evaluation is needed before transplantation, and a careful follow-up is required afterward to ensure an early diagnosis of malignancy. Preventive nephroureterectomy is recommended.
Zivcić-Cosić
Stela
S
Department of Nephrology and Dialysis, Center for Kidney Transplantation, Ministry of Health and Social Welfare of the Republic of Croatia, University Hospital Center Rijeka, Rijeka, Croatia. stela.zivcic-cosic@ri.t-com.hr
Grzetić
Mirjana
M
Valencić
Maksim
M
Oguić
Romano
R
Maricić
Anton
A
Dordević
Gordana
G
Balen
Sanja
S
Orlić
Lidija
L
Racki
Sanjin
S
Fuckar
Zeljko
Z
D000328:Adult; D000368:Aged; D001449:Balkan Nephropathy / Q000150:complications / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000453:epidemiology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D014516:Ureteral Neoplasms / Q000453:epidemiology*; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology*