De novo urothelial carcinoma in kidney transplantation patients with end-stage aristolochic acid nephropathy in China.
BACKGROUND
Aristolochic acid contained in Chinese herbs has been proved to be nephrotoxic and carcinogenic. Immunosuppression is associated with an increased risk of developing malignancies. What will be the result if these two significant risk factors are concomitantly present in transplanted patients with aristolochic acid nephropathy (AAN)?


METHODS
A 2-center cohort of 1,612 renal transplant recipients was studied retrospectively from January 1998 to December 2006. We performed an evaluation of the database and review of the charts and pathology reports of these recipients.


RESULTS
Kidney transplantations were performed in 17 patients with AAN. Nine (52.9%) of these recipients developed urothelial carcinoma (UC), compared with a 0.46% prevalence of urinary tract tumors among kidney-transplanted patients in China. Eight cases (88.9%) involved the upper urinary tract (bilateral, 3 cases, 37.5%; unilateral, 5 cases, 62.5%). All patients underwent surgical treatment. Six patients (75%) had recurrence during the follow-up period. Three patients died within a mean of 20 months after tumor excision.


CONCLUSIONS
The risk for UC is distinctly increased in patients with AAN after transplantation. Regular screening for early detection of malignancy is mandatory.
Yuan
Ming
M
Department of Urology, Organ Transplantation Center, Second Affiliated Hospital, General Hospital of the Chinese PLA, Beijing, PR China.
Shi
Bing-Yi
BY
Li
Han-Zhong
HZ
Xia
Ming
M
Han
Yong
Y
Xu
Xiao-Guang
XG
Zhang
Yin-Sheng
YS
D000328:Adult; D000368:Aged; D034341:Aristolochic Acids / Q000009:adverse effects*; D002295:Carcinoma, Transitional Cell / Q000209:etiology*; D002681:China; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000139:chemically induced* / Q000150:complications*; D007680:Kidney Neoplasms / Q000209:etiology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies
D034341:Aristolochic Acids