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Abstract
PURPOSE OF REVIEW The aim of this article is to review incidence, risk factors, and optimal management of de-novo urothelial carcinoma in transplant recipients. RECENT FINDINGS There is a two to three-fold increased risk for de-novo malignant tumors after solid-organ transplantation, but there is currently no consensus regarding optimal management of de-novo urothelial carcinoma in transplanted patients. Known risk factors include polyomavirus BK, aristolochic acid, and smoking. Data suggest a higher rate of high-grade tumors, as well as predominantly higher stage at primary diagnosis, for both NMIBC and muscle-invasive bladder cancer (MIBC). Treatment for NMIBC includes TURB, mitomycin, and Bacille de Calmette-Guérin instillation with special concern to the immunosuppressive regime. Treatment of MIBC or advanced urothelial carcinoma includes radical cystectomy with chemotherapy if the patient is eligible. A screening should be performed in all transplant recipients, to allow early diagnosis. SUMMARY De-novo urothelial carcinoma in transplant recipients is more frequent than in the general population and these tumors were more likely to be high-grade tumors and diagnosed at an advanced stage. There is very little information available on the optimal treatment for these patients. However, aggressive treatment and a strict management according the given recommendations are of the utmost importance.
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Lee Y, Hung S, Wang H, Lin C, Wang H, Chang M, Sung J, Chiou Y, Lin S. Is there different risk of cancer among end-stage renal disease patients undergoing hemodialysis and peritoneal dialysis? Cancer Med 2018; 7:485-498. [PMID: 29356425 PMCID: PMC5806101 DOI: 10.1002/cam4.1289] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 01/02/2023] Open
Abstract
Cancer is a global issue in recent decade. Despite this alarming increase in the incidence of cancer, to date, whether the risk of developing cancer differs among peritoneal dialysis (PD) and hemodialysis (HD) patients is still uncertain. In this retrospective cohort study, data were obtained from the National Health Insurance Research Database of Taiwan, which provides coverage to almost 99% of the nation's population. After matching, a total of 4491 (or 3369) incident PD patients and 8982 (or 6738) incident HD patients between 2000 and 2009 were enrolled from the database. In addition, 22,455 (or 16,845) nondialysis patients were selected as a control group. The patients were monitored for the occurrence of cancer until 2010, and their data were analyzed using several different models. In general, the results showed that the risks of hepatocellular, kidney, bladder, extra kidney/bladder urinary tract, and thyroid cancers were higher in dialysis patients. We also compared the risk of cancer between two dialysis groups by using the HD patients as the reference group. The result showed that there is no significant different for each cancer risk between two dialysis groups. In conclusion, dialysis patients had a higher risk of certain types of cancer than those in the nonuremia group. However, there was no significant difference in the cancer risk between the two dialysis groups when compared directly.
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Affiliation(s)
- Yi‐Che Lee
- Division of NephrologyDepartment of Internal MedicineE‐DA Dachang Hospital/ I‐Shou UniversityKaohsiungTaiwan
| | - Shih‐Yuan Hung
- Division of NephrologyDepartment of Internal MedicineE‐DA Dachang Hospital/ I‐Shou UniversityKaohsiungTaiwan
- School of Medicine for International StudentsE‐DA Hospital/ I‐Shou UniversityKaohsiungTaiwan
| | - Hao‐Kuang Wang
- School of Medicine for International StudentsE‐DA Hospital/ I‐Shou UniversityKaohsiungTaiwan
- Department of NeurosurgeryE‐DA Hospital/ I‐Shou UniversityKaohsiungTaiwan
| | - Chi‐Wei Lin
- School of Medicine for International StudentsE‐DA Hospital/ I‐Shou UniversityKaohsiungTaiwan
- Department of Medical EducationE‐DA Hospital/ I‐Shou UniversityKaohsiungTaiwan
| | - Hsi‐Hao Wang
- Division of NephrologyDepartment of Internal MedicineE‐DA Dachang Hospital/ I‐Shou UniversityKaohsiungTaiwan
| | - Min‐Yu Chang
- Division of NephrologyDepartment of Internal MedicineE‐DA Dachang Hospital/ I‐Shou UniversityKaohsiungTaiwan
| | - Junne‐Ming Sung
- Division of NephrologyDepartment of Internal MedicineNational Cheng Kung University HospitalTainanTaiwan
| | - Yuan‐Yow Chiou
- Department of PediatricsNational Cheng Kung University HospitalTainanTaiwan
- Institute of Clinical MedicineCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Sheng‐Hsiang Lin
- Institute of Clinical MedicineCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
- Biostatistics Consulting CenterNational Cheng Kung University HospitalTainanTaiwan
- Department of Public HealthCollege of MedicineNational Cheng‐Kung UniversityTainanTaiwan
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Interplay between chronic kidney disease (CKD) and upper tract urothelial carcinomas (UUC): foe or friend? Oncotarget 2016; 7:53951-53958. [PMID: 27256983 PMCID: PMC5288235 DOI: 10.18632/oncotarget.9753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/23/2016] [Indexed: 02/07/2023] Open
Abstract
Although upper tract urothelial carcinomas (UUC) is curable through nephrectomy or nephroureterectomy, progression of chronic kidney disease (CKD) and CKD-related mortality have been highlighted as clinical challenges in recent years owing to the loss of a large number of nephrons. While CKD can promote the development of UUC, other risk factors such as hypertension, diabetes mellitus, advanced age, and anemia can facilitate the progression of CKD. Conversely, CKD is especially prevalent in UUC patients. However, the relationship between CKD and UUC, mechanisms for CKD causing UUC, and gender disparity of UUC of CKD patients have so far not been well-reviewed. As UUC gradually grows, the cancer can be a physical obstacle in the urinary tract. It will cause an increased tract pressure, subsequently resulting in the dysfunction of both nephrons and kidney. At the molecular level, reduced level of oxidative stress was observed in female UUC patients. Furthermore, radical nephrectomy therapy for UUC patients accelerates the progress of chronic kidney dysfunction. Incidentally, the remedies for CKD containing aristolochic acid (AA) are carcinogenic. Our present review offers a comprehensive look at the relationship between CKD and UUC from multiple perspectives. Early and precise identification of progression of CKD and UUC will benefit the patients at high-risk of CKD or UUC, which will also be instructive in directing timely and effective therapeutic interventions whenever necessary. It may also shed light on unveiling the underlying mechanisms of carcinogenesis of UUC, preventing CKD progression, and prolonging the patients' overall survival.
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Medani S, O'Kelly P, O'Brien KM, Mohan P, Magee C, Conlon P. Bladder cancer in renal allograft recipients: risk factors and outcomes. Transplant Proc 2015; 46:3466-73. [PMID: 25498074 DOI: 10.1016/j.transproceed.2014.06.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/13/2014] [Accepted: 06/17/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Solid organ transplant recipients have an increased cancer risk owing to immunosuppression and oncogenic viral infections. We report on the incidence and types of bladder cancer in kidney transplant recipients in Ireland, describing possible additional risk factors and outcomes in these patients. METHODS We identified kidney transplant recipients diagnosed with de novo bladder cancer between January 1, 1994, and July 31, 2012, by integrating data from the Irish National Cancer Registry and National Renal Transplant Registry. We calculated the standardized incidence ratio (SIR) and examined patient and tumor characteristics and 1-year survival rate. RESULTS Fifteen patients were diagnosed with de novo bladder cancer during the study period, representing 0.48% of kidney transplant recipients. The SIR was 2.5 (95% CI, 1.4-4.2; P < .001). The mean interval between transplantation and diagnosis of bladder tumor was 8.6 years and mean age at time of diagnosis was 55.7 years. Sixty percent of patients were male. The tumor types were transitional cell carcinoma (9 patients), squamous cell carcinoma (3 patients), adenocarcinoma (1 patient), carcinoma in situ (1 patient), and diffuse large B-cell lymphoma (1 patient). Beside immunosuppression, risk factors associated with bladder cancer were urogenital disease (6 patients), cyclophosphamide exposure (2 patients), BK nephropathy (1 patient), analgesic nephropathy (1 patient), and extensive smoking (1 patient). Eight patients underwent radical cystectomy for invasive tumors, with resection of other pelvic organs in 7 patients. Mortality rate within the first year was 40%. CONCLUSION Bladder cancer occurred more commonly in kidney transplant recipients with a predominance of aggressive tumors and a high mortality. In patients with preexisting risk factors such as urologic abnormalities and cyclophosphamide exposure careful assessment before transplantation and vigilant monitoring posttransplantation with a low threshold for cystoscopy may improve outcomes.
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Affiliation(s)
- S Medani
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland.
| | - P O'Kelly
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland
| | | | - P Mohan
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland
| | - C Magee
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland
| | - P Conlon
- Department of Nephrology, Urology & Transplantation, Beaumont Hospital, Dublin, Ireland
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Distinguishing characteristics of urothelial carcinoma in kidney transplant recipients between China and Western countries. Transplant Proc 2013; 45:2197-202. [PMID: 23747184 DOI: 10.1016/j.transproceed.2012.10.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/09/2012] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To identify significant distinctive characteristics of urothelial carcinoma (UC) in kidney transplant recipients between China and Western countries and investigate probable tumor screening and treatment factors contributing to these differences. METHODS Renal transplant recipients from 1998 to 2011 in our institution diagnosed with UC were included in this study. Our data on tumor incidence, clinical characteristics, and outcomes were compared with literature reports. RESULTS Among 2572 renal transplant recipients identified, 24 (0.93%) experienced UC, including 10 men and 14 women of overall mean age of 49.3 ± 11.6 years at transplantation and 53.5 ± 9.5 years at tumor detection. The Chinese traditional herbal intake mainly focused on 2 preparations: Aristolochic acid and rhubarb (the latter was mainly used in patients with chronic renal impairment) in 20 people. There were 21 (87.5%) cases of upper (UTUC) 5 cases of bilateral, and 13 cases of multifocal urinary tract urothelial carcinoma. Four subjects died owing to tumor progression at 4-63 months postoperatively. CONCLUSIONS UC in renal transplant recipients shared notable characteristics in China with widespread herb intake: UTUC predominance; multifocal and bilateral organ involvement; high rates of recurrence, progression, and dissemination, in contrast with bladder tumor dominance in Western countries. As a consequence, we suggest that bilateral nephroureterectomy should be performed prophylactically in high-risk patients, especially those with a long history of Chinese herb intake. The relationship of rhubarb consumption to UC in renal transplant recipients should be noted and evaluated.
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Rogers A, Koo Ng J, Glendinning J, Rix D. The management of transitional cell carcinoma (TCC) in a European regional renal transplant population. BJU Int 2012; 110:E34-40. [DOI: 10.1111/j.1464-410x.2011.10777.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Husain E, Khawaja A, Shaikh T, Yaqoob M, Junaid I, Baithun S. Transitional cell carcinoma of the urinary tract in renal transplant recipients. Pathology 2009; 41:406-8. [DOI: 10.1080/00313020902886936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Selli C, Boggi U, Travaglini F, Vistoli F, Chiaro M, Mosca F. Cystectomy and orthotopic ileal neobladder in a male patient 12 years after kidney transplantation; good preservation of the renal function. Transpl Int 2004. [DOI: 10.1111/j.1432-2277.2004.tb00410.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wang HB, Hsieh HH, Chen YT, Chiang CY, Cheng YT. The outcome of post-transplant transitional cell carcinoma in 10 renal transplant recipients. Clin Transplant 2002; 16:410-3. [PMID: 12437619 DOI: 10.1034/j.1399-0012.2002.01152.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
At our clinic we followed 320 renal transplant recipients, 16 of whom developed malignancies within 15 yr. Ten of the 16 malignancies were transitional cell carcinoma (TCC) of the urinary tract. The modalities of treatment included standard nephroureterectomy with bladder cuff removal for upper tract tumor, transurethral resection for superficial bladder tumor and partial cystectomy for one case of invasive bladder tumor, as requested by the patient. Post-operative intravesical chemotherapy with epirubicin, or immunotherapy with bacillus Calmette-Guerin (BCG) were carried out for superficial bladder tumor. Cyclosporine (CsA) used as post-transplant immunosuppressant was switched to low dose azathioprine (Aza) at the initial diagnosis of TCC. Four patients experienced tumor recurrence despite conversion of immunosuppressant from CsA to Aza. Among these 10 patients, five maintained normal renal function, three returned to hemodialysis without tumor recurrence, and two patients died of cancer.
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Affiliation(s)
- Hwa-Ben Wang
- Division of Urology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung Hsien, Taiwan
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ORTHOTOPIC NEOBLADDER AFTER KIDNEY TRANSPLANTATION IN A MALE PATIENT WITH RECURRING UROTHELIAL CARCINOMA AND RENAL CANCER. J Urol 2001. [DOI: 10.1097/00005392-200110000-00037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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GIESSING MARKUS, TÜRK INGOLF, SCHOENBERGER BERND, LOENING STEFANA. ORTHOTOPIC NEOBLADDER AFTER KIDNEY TRANSPLANTATION IN A MALE PATIENT WITH RECURRING UROTHELIAL CARCINOMA AND RENAL CANCER. J Urol 2001. [DOI: 10.1016/s0022-5347(05)65776-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- MARKUS GIESSING
- From the Department of Urology, Charité University Hospital, Berlin, Germany
| | - INGOLF TÜRK
- From the Department of Urology, Charité University Hospital, Berlin, Germany
| | - BERND SCHOENBERGER
- From the Department of Urology, Charité University Hospital, Berlin, Germany
| | - STEFAN A. LOENING
- From the Department of Urology, Charité University Hospital, Berlin, Germany
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Doehn C, Fornara P, Fricke L, Jocham D. Laparoscopic nephroureterectomy to exclude upper urinary tract malignancy associated with analgesic nephropathy. J Endourol 2001; 15:809-14. [PMID: 11724120 DOI: 10.1089/089277901753205807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Analgesic abuse is a potential cause of end-stage renal disease. Such patients bear an elevated risk of developing malignancies, predominantly transitional-cell carcinoma. We report our experience with laparoscopic nephroureterectomy carried out in patients with analgesic nephropathy to exclude upper urinary tract malignancy. All patients were scheduled to be put on the waiting list for cadaveric renal transplantation. PATIENTS AND METHODS Since 1996, nine women and two men with a long-term history of analgesic abuse have undergone laparoscopic nephroureterectomy at our hospital. The median age was 63 years (range 51-70 years). All patients had developed end-stage renal failure secondary to heavy analgesic abuse with a median duration of 14 years (range 7-40 years). The median interval from the beginning of hemodialysis to laparoscopic nephroureterectomy was 36 months (range 6-76 months). RESULTS The median operative time was 99 minutes (range 55-170 minutes). There were no conversions to open surgery. Two complications occurred, and three patients required blood transfusions. The median hospital stay lasted 5 days (range 2-12 days), and the median convalescence was 20 days (range 6-44 days). In seven patients, histopathologic examination of the kidney revealed changes attributable to analgesic abuse. None of the patients had a transitional-cell carcinoma, but in two patients, a renal-cell carcinoma stage pT1cN0cM0 grade 2 was detected. CONCLUSION Patients with analgesic nephropathy bear an elevated risk for the development of transitional-cell or renal-cell carcinoma. In these patients, laparoscopic nephroureterectomy combines minimally operative invasiveness with a maximum of diagnostic safety.
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Affiliation(s)
- C Doehn
- Department of Urology, Medical University of Lübeck, Germany.
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El-Mekresh M, Osman Y, Ali-El-Dein B, El-Diasty T, Ghoneim MA. Urological complications after living-donor renal transplantation. BJU Int 2001. [PMID: 11251519 DOI: 10.1046/j.1464-410x.2001.00113.x-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To determine the incidence and management of urological complications after 1200 consecutive live-donor renal transplantations, all of which were carried out in one centre; the possible risk factors and the effect on patient and graft survival were also assessed. PATIENTS AND METHODS Data were retrieved from an electronic database; the incidence of urological complications was determined, and correlated with relevant risk factors by univariate and multivariate analysis. The effect on patient and graft survival was assessed using Kaplan-Meier statistics. RESULTS There were 100 complications in 96 patients (8%); urinary leaks occurred in 37, ureteric strictures in 23 and lymphoceles causing ureteric obstruction in 17. Percutaneous needle biopsy was complicated by haematuria and clot anuria in six patients. Late complications included 11 cases of stones, four of bladder malignancy and two of haemorrhagic cystitis. There was evidence that the age of the recipients (< 10 years), method of establishing urinary continuity (uretero-ureteric anastomosis) and a high dose of steroids had an independent positive effect on the incidence of urological complications. However, their development did not influence graft or patient survival. CONCLUSION When there is meticulous attention to the technical details, renal transplantation should incur few urological complications. Early intervention with percutaneous drainage reduces morbidity and the likelihood loss of graft function. Proper and prompt management should not affect the graft and/or the patient's survival.
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Affiliation(s)
- M El-Mekresh
- The Urology & Nephrology Centre, Mansoura, Egypt
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Nicol D, Hirst G. Urological assessment and complications in renal transplantation. Transplant Rev (Orlando) 1999. [DOI: 10.1016/s0955-470x(99)80003-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Colombo T, Zigeuner R, Zitta S, Petritsch PH, Hubmer G. Orthotopic neobladder in a woman after kidney transplantation. J Urol 1997; 158:2236-7. [PMID: 9366357 DOI: 10.1016/s0022-5347(01)68212-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- T Colombo
- Universitätsklinik für Urologie and Medizinische Universitätsklinik, Karl-Franzens-Universität, Graz, Austria
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