Urological tumors in renal transplantation.
The aim of this paper was to review the risk and incidence of urological malignancies and the clinical characteristics and outcomes of renal transplant urological malignancies. Medline/PubMed from January 1980 to February 2013 was searched to identify all medical literature about native kidney, graft bladder and prostate cancers. Comparing to general population, risk of kidney cancer was found to be 7 to 10 times greater and most of them are incidental low-stage, low-grade tumors with a good prognosis. Open and laparoscopic radical nephrectomies without lymph nodes dissection were reported to be safe. Incidence of graft RCC was 0.19%. Papillary carcinomas represented more than 50% of de novo graft carcinomas, which seemed to be low-grade carcinomas with good prognosis. Risk of prostate cancer was two times higher. Open or laparoscopic radical prostatectomy is safe and feasible for management of localized prostate cancer in patients with kidney allograft. Upper urinary tract (UUT) transitional cell carcinoma (TCC) incidence was reported between 0.7% and 3.8%. Reports suggested a 3-fold increased risk of developing bladder TCC. Intravesical BCG in superficial bladder cancer and/or CIS is a valid option. For invasive urothelial tumor, radical cystectomy in renal transplant patients remains the best treatment. Oncological outcomes of urological cancers in renal transplant recipients are good and conservative treatment should be preferred each time it is feasible to prevent returning to dialysis following recommendations of urological cancer treatment. Close monitoring of renal transplant recipient must be performed with at least an abdominopelvic US and PSA measurement once a year.
Urology and Transplantation Department, CHU de Caen, Caen, France - xavtillou@gmail.com.
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Tillou
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Doerfler
D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D012307:Risk Factors; D014571:Urologic Neoplasms / Q000453:epidemiology / Q000209:etiology*