High Incidence of Transitional Cell Carcinoma in Kidney Transplant Recipients in Eastern Taiwan

Jing-Liang Chen ^{a, b}, Guan-Jin Ho ^c, Ying-Chin Yang ^c, Ming-Hui Shih ^d, Kuei-Chun Chou ^d, Ming-Che Lee ^{c, e}

^aDepartment of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^bGraduate Institute of Human Genetics, Tzu Chi University, Hualien, Taiwan
^cDepartment of Surgery, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^dDepartment of Nursing, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^eInstitute of Medical Sciences, Tzu Chi University, Hualien, Taiwan

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Abstract

Objective
A higher incidence of urinary tract transitional cell carcinoma (TCC) has been reported in both long-term hemodialysis patients and kidney transplant (KTX) recipients in Taiwan than in other countries. Herein, we report a high incidence of urinary tract malignancy, especially TCC, in KTX recipients in eastern Taiwan.
Patients and Methods
We retrospectively reviewed the medical records, clinical data, and outcomes of 102 KTX recipients in Tzu Chi General Hospital from 1992 to 2008. Overall graft and patient survival, incidence of posttransplant malignancy, and cumulative incidence of TCC after KTX were investigated.
Results
During a mean follow-up of 45.5 ± 38.5 months after KTX, 12 malignancies were diagnosed in nine recipients. The incidence of post-transplant malignancy in all recipients was 8.2%. TCC was diagnosed in four patients, and all these patients presented with painless gross hematuria and hydronephrosis. Three patients had tumor involvement in the upper urinary tract. TCC occurred at a mean of 56 ± 70.7 months after KTX, and the cumulative incidence of TCC was 4.7% in the first 3 years after transplant. Only one patient with triple cancer died of disseminated cholangiocarcinoma of the distal common bile duct during a mean follow-up of 15.8 ± 9.5 months after surgical treatment of TCC.
Conclusion
KTX recipients are at extremely high risk of TCC in eastern Taiwan, with an incidence of 3.9%. The cardinal signs of posttransplant TCC are painless gross hematuria and hydronephrosis of the native kidney. Careful, timely urological screening in KTX recipients warrants early diagnosis and good prognosis after aggressive surgical management.

Keywords

Kidney transplantation; Posttransplant malignancy; Recipient; Transitional cell carcinoma