Transitional cell carcinoma in renal transplant recipients

We describe our experience in managing transitional cell carcinoma (TCC) in renal transplant (RTx) recipients. Nineteen RTx recipients (7 men; 12 women) presented with hematuria or hydronephrosis of native kidneys and were suspected with TCC were reviewed retrospectively; 17 of them proved to have TCC. The mean interval of the occurrence of TCC was 58.7 months (range, 3-144 months) after RTx. The patients with suspected upper tract lesions received bilateral nephroureterectomies (BNU) and bladder cuff resection. Transurethral resection of the bladder tumor (TUR-BT) was performed in patients with concomitant or solitary superficial bladder lesions. Of the 15 patients with upper tract TCC, 8 had bilateral lesions pathologically, but only 2 of them were suspected preoperatively on image study. With a mean follow-up of 28 months (range, 1-57 months) both the overall graft and patient survival rates were 76%; 4 patients with advanced diseases at presentation died. Bladder recurrence was noted in 6 patients (35%). Transplant patients with hematuria warrant detailed study of the whole urinary system and periodic ultrasonography of the native kidneys is recommended in all RTx recipients. Simultaneous BNU for the native kidneys is mandatory if there is any evidence of TCC in either renal/ureteral unit.