Late onset of bladder urothelial carcinoma after kidney transplantation for end-stage aristolochic acid nephropathy: a case series with 15-year follow-up.
BACKGROUND
Aristolochic acids are nephrotoxins and predispose to upper-tract urothelial carcinoma. The risk of bladder urothelial carcinoma after kidney transplantation and its relationship to upper-tract urothelial carcinoma is not well defined.


METHODS
Case series.


METHODS
Single-center cohort of 38 women given kidney transplants for end-stage aristolochic acid nephropathy.


METHODS
The prevalence of upper urinary tract urothelial carcinoma was determined by collecting pathological results of specimens obtained by means of bilateral ureteronephrectomy. We also established the cumulative incidence of bladder urothelial carcinoma in biopsies performed during prospective screening cystoscopies during a 15-year follow-up.


RESULTS
Upper-tract urothelial carcinoma was found in 17 patients with aristolochic acid nephropathy (44.7%). During follow-up, bladder urothelial carcinoma was diagnosed in 15 patients 68 to 169 months after cessation of aristolochic acid exposure (39.5%): 8 urothelial carcinoma in situ, 4 noninvasive low-grade papillary urothelial carcinoma, and 3 infiltrating urothelial carcinoma. 12 of 17 patients (71%) with a history of upper-tract urothelial carcinoma developed bladder urothelial carcinoma during follow-up, whereas this occurred in only 3 of 21 patients (14%) without upper-tract urothelial carcinoma (P < 0.01). Despite local and/or systemic chemotherapy, 3 patients died and 2 radical cystectomies were performed.


CONCLUSIONS
Small sample size of this case series.


CONCLUSIONS
Upper-tract and bladder urothelial carcinoma are dramatic complications in kidney transplant recipients with aristolochic acid nephropathy, confirming the carcinogenic properties of aristolochic acids. We identified upper-tract urothelial carcinoma as a potent risk factor for the subsequent development of bladder urothelial carcinoma after kidney transplantation for aristolochic acid nephropathy. Because this complication may occur years after aristolochic acid discontinuation, we suggest regular cystoscopies in addition to the bilateral ureteronephrectomy in kidney transplant recipients with aristolochic acid nephropathy.
Lemy
Anne
A
Department of Nephrology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Wissing
Karl M
KM
Rorive
Sandrine
S
Zlotta
Alexandre
A
Roumeguere
Thierry
T
Muniz Martinez
Marie-Carmen
MC
Decaestecker
Christine
C
Salmon
Isabelle
I
Abramowicz
Daniel
D
Vanherweghem
Jean-Louis
JL
Nortier
Joëlle
J
D000283:Administration, Intravesical; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D034341:Aristolochic Acids / Q000009:adverse effects; D002273:Carcinogens; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000139:chemically induced* / Q000601:surgery*; D016030:Kidney Transplantation; D016685:Mitomycin / Q000008:administration & dosage; D018570:Risk Assessment; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000139:chemically induced* / Q000188:drug therapy
D000903:Antibiotics, Antineoplastic; D034341:Aristolochic Acids; D002273:Carcinogens; D004365:Drugs, Chinese Herbal; D016685:Mitomycin; C000228:aristolochic acid I