title: Outcomes of kidney transplant tourism and risk factors for de novo urothelial carcinoma.
abstract: BACKGROUND
  To date, the outcomes of transplant tourism have not been reported extensively. In addition, data about the accuracy of urine cytology for the detection and the role of the BK virus (BKV) in the carcinogenesis of urothelial carcinoma (UC) after renal transplantation are lacking.
  
  
  METHODS
  Three hundred seven patients who received deceased donor kidney transplants between January 2003 and December 2009 were retrospectively studied. The clinical parameters and outcomes between the domestic and tourist groups were compared. We also investigated the risk factors and role of BKV in the carcinogenesis of de novo UC by quantitative real-time polymerase chain reaction.
  
  
  RESULTS
  The subjects in the tourist group were older at transplantation and had a shorter dialysis time before transplantation. There were significantly higher incidence rates of BKV viruria, Pneumocystis jiroveci pneumonia, and malignancy in the tourist group. Graft and patient survival were superior in the domestic group. A total of 43 cancers were identified, and the most common type of malignancy was UC (23 patients, 53.5%). The tourist group had a significantly higher incidence of tumors. The sensitivity and specificity of urine cytology for detecting UC were 73.9% and 94.7%, respectively. Independent predictors of UC included female sex, use of Chinese herbal medicine, and transplant tourism. Only two patients (8.7%) with UC had detectable BKV.
  
  
  CONCLUSIONS
  Transplant tourism was a risk factor for infection and de novo malignancy. Urothelial carcinoma was the most common malignancy after kidney transplantation. Regular screening for the early detection of UC by urine cytology or periodic sonographic surveys is mandatory, especially for those at high risk.
authors.affiliation: 1 Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan. 3 Division of Pediatric Immunology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan. 4 Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 5 Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. 6 Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 7 Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 8 Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. 9 Address correspondence to: Jei-Wen Chang, M.D., Ph.D., Division of Pediatric Immunology, Department of Pediatrics, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, Taiwan, 11217; and Che-Chuan Loong, M.D., Ph.D., Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, Taiwan, 11217.
authors.forename: Hsin-Lin
authors.initials: HL
authors.lastname: Tsai
authors.forename: Jei-Wen
authors.initials: JW
authors.lastname: Chang
authors.forename: Tsai-Hun
authors.initials: TH
authors.lastname: Wu
authors.forename: Kuang-Liang
authors.initials: KL
authors.lastname: King
authors.forename: Ling-Yu
authors.initials: LY
authors.lastname: Yang
authors.forename: Yu-Jiun
authors.initials: YJ
authors.lastname: Chan
authors.forename: An-Hang
authors.initials: AH
authors.lastname: Yang
authors.forename: Fu-Pang
authors.initials: FP
authors.lastname: Chang
authors.forename: Chin-Chen
authors.initials: CC
authors.lastname: Pan
authors.forename: Wu-Chang
authors.initials: WC
authors.lastname: Yang
authors.forename: Che-Chuan
authors.initials: CC
authors.lastname: Loong
mesh_terms: D000328:Adult; D001739:BK Virus / Q000235:genetics; D002277:Carcinoma / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000821:virology; D004279:DNA, Viral / Q000097:blood / Q000652:urine; D004365:Drugs, Chinese Herbal / Q000009:adverse effects; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D057193:Medical Tourism; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000821:virology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014412:Tumor Virus Infections / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000821:virology; D014571:Urologic Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000821:virology; D019459:Urothelium / Q000473:pathology* / Q000821:virology
chemical_list: D004279:DNA, Viral; D004365:Drugs, Chinese Herbal