Urothelial Cancer in Renal Transplant Recipients: Incidence, Risk Factors and Oncological Outcome

To evaluate the incidence and risk factors for urothelial cancer (UC) as well as the oncological outcome and allograft function in renal transplant recipients.

Retrospective analysis of 1855 consecutive patients undergoing renal transplantation (TX) between 02/1982 and 05/2014 at a single centre.

UC incidence, overall and cancer-specific survival, recurrence and progression rates, risk factors for UC and renal function were determined. Fisher's exact test and log rank Mantel-Cox test were used as appropriate.

In renal transplant recipients, incidence of de novo UC was 1. 35% (25/1855). Deceased donor transplantation (p = 0. 002), increased age at transplantation (p = 0. 011) and analgesic abuse (p = 0. 005) were significant risk factors for the development of UC post-TX. Progression rate and recurrence rate were doubled for post-TX-UC but stable for patients with pre-TX-UC compared with the general population. Analgesic abuse was associated with worse cancer specific and overall survival in post-TX patients. The overall survival status was significantly lower for post-TX patients at a median of 34mos versus 222mos in control patients. Adjuvant treatment was scarcely used. UC had no significant influence on graft function.

A higher incidence of UC was identified in renal transplant recipients compared with that for the general population. These observations justify screening for UC in renal transplant patients, especially considering that, in a large proportion, a tentative diagnosis was possible with non-invasive urine analysis. Prudent adjuvant treatment for UC should be used. Limitations of this study were the retrospective design and the single centre experience.

Urology. 2015 Dec 07 [Epub ahead of print]

Peter U Ardelt, Malte Rieken, Jan Ebbing, Gernot Bonkat, Tatjana Vlajnic, Lukas Bubendorf, Rainer Grobholz, Jürg Steiger, Alexander Bachmann, Felix Burkhalter

Department of Urology, University Hospital Basel, Switzerland. Department of Urology, University Hospital Basel, Switzerland. , Department of Urology, University Hospital Basel, Switzerland. , Department of Urology, University Hospital Basel, Switzerland. , Institute of Pathology, University Hospital Basel, Switzerland. , Institute of Pathology, University Hospital Basel, Switzerland. , Institute of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland. , Department of Transplant Immunology & Nephrology, University Hospital Basel, Switzerland. , Department of Urology, University Hospital Basel, Switzerland. , Department of Transplant Immunology & Nephrology, University Hospital Basel, Switzerland.

PubMed