title: Urothelial cancer in patients with Endemic Balkan Nephropathy (EN) after renal transplantation.
abstract: 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.
authors.affiliation: 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
authors.forename: Stela
authors.initials: S
authors.lastname: Zivcić-Cosić
authors.forename: Mirjana
authors.initials: M
authors.lastname: Grzetić
authors.forename: Maksim
authors.initials: M
authors.lastname: Valencić
authors.forename: Romano
authors.initials: R
authors.lastname: Oguić
authors.forename: Anton
authors.initials: A
authors.lastname: Maricić
authors.forename: Gordana
authors.initials: G
authors.lastname: Dordević
authors.forename: Sanja
authors.initials: S
authors.lastname: Balen
authors.forename: Lidija
authors.initials: L
authors.lastname: Orlić
authors.forename: Sanjin
authors.initials: S
authors.lastname: Racki
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Fuckar
mesh_terms: 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*