title: Long-term Outcome of Kidney Recipients Transplanted for Aristolochic Acid Nephropathy.
abstract: BACKGROUND
  Aristolochic acids (AA) are nephrotoxic and carcinogenic. The aim of this study was to assess the long-term outcome of patients with AA nephropathy (AAN) after kidney transplantation.
  
  
  METHODS
  Observational study. Patients' characteristics, long-term surveillance and follow-up data, patient and graft survival, as well as outcomes with respect to rejection, cardiovascular complications, infections, and cancers with a focus on urothelial carcinomas, are reported.
  
  
  RESULTS
  Twenty patients transplanted for AAN were included. All were submitted to prophylactic bilateral ureteronephrectomy and annual surveillance of the bladder. Median duration of posttransplant follow-up was 12.5 (3-19) years. Time from diagnosis of AAN to renal replacement therapy was relatively short (1 [0-15] years). Immunosuppression consisted of a triple therapy in the majority of patients. Nineteen patients had upper urinary tract multifocal atypia. Eleven patients presented with urothelial carcinomas of the upper tract; 2 of them with additional bladder urothelial carcinomas. Of these 2 patients, one required radical cystectomy. One patient developed a hepatocarcinoma. Patient survival was 100% in AAN patients at 5, 10, and 15 years after transplantation. Graft survival at 5, 10, and 15 years was 95%, 83%, and 75%.
  
  
  CONCLUSIONS
  Despite a high prevalence of urothelial carcinoma and the risk of bladder carcinoma, the long-term patient and kidney graft survival is excellent in patients with AAN, provided that prophylactic bilateral ureteronephrectomy and lifelong surveillance of the bladder are performed.
authors.affiliation: 1 Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. 2 Division of Gastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. 3 Division of Surgery and Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. 4 Division of Pathology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. 5 Division of Radiopharmaceutical Chemistry, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Nada
authors.initials: N
authors.lastname: Kanaan
authors.forename: Ziad
authors.initials: Z
authors.lastname: Hassoun
authors.forename: Claudia
authors.initials: C
authors.lastname: Raggi
authors.forename: Michel
authors.initials: M
authors.lastname: Jadoul
authors.forename: Michel
authors.initials: M
authors.lastname: Mourad
authors.forename: Martine
authors.initials: M
authors.lastname: De Meyer
authors.forename: Selda
authors.initials: S
authors.lastname: Aydin
authors.forename: Heinz H
authors.initials: HH
authors.lastname: Schmeiser
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cosyns
authors.forename: Eric
authors.initials: E
authors.lastname: Goffin
mesh_terms: D000328:Adult; D000368:Aged; D034341:Aristolochic Acids / Q000009:adverse effects*; D001530:Belgium; D002277:Carcinoma / Q000139:chemically induced / Q000473:pathology; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000139:chemically induced / Q000473:pathology; D019459:Urothelium / Q000187:drug effects / Q000473:pathology
chemical_list: D034341:Aristolochic Acids; D007166:Immunosuppressive Agents; C000228:aristolochic acid I