Clinical character of renal transplant recipients with bilateral native upper urinary transitional cell carcinoma

Abstract

To analysis the clinical character of renal transplant (RTx) recipients with bilateral native upper urinary transitional cell carcinoma. The clinical data of 7 cases of transitional cell carcinoma in 2236 RTx recipients who underwent non-synchronous native bilateral nephroureterectomy (BNU) for 14 case-times were retrospectively analyzed. The mean time between RTx and diagnosis of TCC was 49.7 months (24 - 96 months). The mean interval between 2 upper urinary tract operations was 14.0 months (2 - 36 months). All specimens obtained in the 14 operations were TCC-positive. The TCC location involved pure native pelvis (n = 2), pure native ureter (n = 4), and pelvis combined with ureter (n = 8). The TCC pathological grades include G(1)-G(2) (n = 7), G3 (n = 6), and cancer in situ (n = 1). The TCC stage status included pTIS (n = 1), pT(1) N(0)M(0) (n = 4), pT(2)N(0)M(0) (n = 6), pT(3)N(0)M(0) (n = 2), and pT(4)N(2)M(1) (n = 1). Five patients were observed to have TCC in bladder. Each patient underwent more then 2 times of transurethral resection of bladder tumor (TUR-Bt). The bladder TCC was at G(2)-G(3) with deep of superficial muscle involvement. Metastasis was found in skin, soft tissue, and costal bone of lumbar in one patient. The blood creatinine level of the 7 patients, representing the graft's function, was 120 micromol/L (97 - 161 micromol/L). The patients were followed up for 2 - 48 months, all patients survived. TCC after RTx has multiple sources and is invasive. Non-synchronous prophylactic native BNU with removal of bladder cuffs should be considered for those RTx recipients having multiple urinary tract malignancy in native upper urinary tract and bladder.