title: Transitional cell carcinoma of the native urinary tract after kidney transplantation: recommendations following a long-term retrospective analysis.
abstract: BACKGROUND
  The aim of the current study was to explore the clinico-oncological characteristics, and the therapeutic and survival parameters, of renal transplant recipients who developed de novo transitional cell carcinoma (TCC) over a 30-year period at the authors' center.
  
  
  METHODS
  Retrospective analysis of records from all registered patients who underwent kidney transplantation at the center between November 1979 and January 2010 who developed de novo TCC of the urinary tract.
  
  
  RESULTS
  From all 2001 patients analyzed during the study period, 21 recipients developed 19 TCCs of the bladder and 6 TCCs of the upper urinary tract. Among bladder TCCs, 13 (68.4%) cases were confined to mucosa (pTa or carcinoma in situ, n = 7) or submucosa (pT1, n = 6) and 6 others (31.6%) infiltrated the detrusor muscle (≥p T2); the grading distribution was 5 cases of G1, 6 of G2 and 8 of G3. All recurrent cases (n = 8) revealed local or systemic progression. The overall and tumor-specific patient survival rates were 80.2%, 54.0% and 30.0% and 84.9%, 67.4% and 58.9% for 1, 5 and 10 years, respectively.
  
  
  CONCLUSIONS
  In the light of the observed increased aggressiveness of TCC in renal transplant recipients, more frequent examinations and possibly more invasive follow-up protocols should be considered for patients with 1 or more risk factors for development of TCC. Urine cytology (including ureteral wash cytology) may be used as a reliable diagnostic tool in these patients. Prophylactic contralateral nephroureterectomy might be an option in patients at high risk.
authors.affiliation: Department of Urology and Pediatric Urology, University Medical Center Frankfurt, Frankfurt, Germany. igor.tsaur@hotmail.com
authors.forename: Igor
authors.initials: I
authors.lastname: Tsaur
authors.forename: Athanasios
authors.initials: A
authors.lastname: Karalis
authors.forename: Roman
authors.initials: R
authors.lastname: Blaheta
authors.forename: Eva
authors.initials: E
authors.lastname: Juengel
authors.forename: Stefan
authors.initials: S
authors.lastname: Vallo
authors.forename: Ernst-Heinrich
authors.initials: EH
authors.lastname: Scheuermann
authors.forename: Heinz-Georg
authors.initials: HG
authors.lastname: Kachel
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Waaga-Gasser
authors.forename: Anil
authors.initials: A
authors.lastname: Chandraker
authors.forename: Nicholas
authors.initials: N
authors.lastname: Obermüller
authors.forename: Michael
authors.initials: M
authors.lastname: Probst
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D003558:Cystoscopy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016019:Survival Analysis; D014421:Turkey / Q000208:ethnology; D014516:Ureteral Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D015022:Yugoslavia / Q000208:ethnology
chemical_list: D007166:Immunosuppressive Agents