Introduction: Kidney transplant (KT) recipients were associated with increased incidence of malignancy due to use of immunosuppressant. Urothelial carcinoma (UC) was one of the leading de novo malignancies following KT. For UC arising from native upper urinary tract after KT, radical nephroureterectomy (RNU) was the gold standard of treatment. We aim to analyze the surgical and oncological outcomes of KT recipients with native upper urinary tract UC underwent RNU.
Methods: We retrospectively reviewed KT patients underwent RNU due to upper tract urothelial carcinoma (UTUC) at our institute from 2005 to 2016. Demographic data and oncologic outcomes were collected from medical records.
Results: A total of 26 patients were included in this study. The average age at RNU was 59.4±12.2 years (range 22-73), and the time interval from KT to RNU was 10.7±5.6 years (range 1.5-20). Five patients (19%) received unilateral RNU. Twenty-one patients (81%) received simultaneous bilateral radical nephroureterectomy (SBRNU). The methods of surgical approach were open in 13 (50%) cases, laparoscopy in 10 (38%) cases, and robotic-assisted in 3 (12%) cases. The perioperative complication rate was 30%, and 11% was = grade III Clavien-Dindo classification. Function loss of the graft kidney was not observed in all cases.
The histopathology results showed 11 (42%) cases were locally advanced stage (pT3/4 or node positive). Twenty-two (85%) patients had multifocal tumors, and 13 (50%) patients had concomitant carcinoma in situ (CIS) lesions. Among 21 patients received SBRNU, synchronous UC in bilateral upper urinary tracts were identified in 11 (52%) patients, while only three of them (27%) had pre-operative image or pathology suspicion of bilateral lesions. Two out of five patients received unilateral RNU eventually experienced contralateral recurrence with mean interval of 5.5 years. The mean follow-up period of our cohort was 46 months (range 2-138). Local recurrence and/or metastasis were observed in 9 (35%) patients. Intravesical recurrences were noted in 14 (54%) patients, with a median time of 8.5 months from surgery to recurrence. The cancer-specific and overall survival rate was 67% and 62%, respectively.
Conclusions: Native UTUC after KT is a unique patient cohort that is commonly associated with multifocal tumors, concomitant CIS lesions, and locally advanced stage, thus warranted timely surgical intervention and further therapy. SBRNU should be performed if possible due to high prevalence of synchronous bilateral UTUC and high contralateral recurrence rate.
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