Urologic malignancy in renal transplant recipients: Analysis of OPTN/UNOS data from 2000 to 2022

The increasing incidence of urologic malignancy after renal transplantation (RT) has become a leading cause of recipient mortality. However, no recent analyses have been performed to identify the risk factors for post-transplant urologic malignancy (PTUM) and to evaluate the effect of PTUM on RT outcomes.

This retrospective, population-based cohort study was based on Organ Procurement and Transplantation Network data.

A total of 268,606 recipients underwent RT from January 2000 to December 2019 and met the inclusion criteria. Of these, 2,079 (0.77%), 1,983 (1.20% of male recipients), and 846 (0.32%) patients were diagnosed with renal cancer (RCa), prostate cancer (PCa), and bladder cancer (BCa), respectively, after RT. Urologic malignancy was a major cause of patient death after RT (RCa: 41.5%, PCa: 23.5%, BCa: 50.4%). The 5-year survival rates of the four groups ranking from best to worst were as follows: [95% confidence interval, lower value-upper value], PCa, 93.3% [92.2%-94.4%]; cancer-free, 87.2% [87.0%-87.3%]; RCa, 87.2% [85.8%-88.7%]; BCa, 81.0% [78.4%-83.7%] (P < 0.001 for all, except cancer-free vs. RCa, P = 1.00).

The effects of PTUM on RT outcomes differ depending on the type of malignancy. Thus, a personalized approach to screening may be an appropriate strategy to address the multitude of complex issues that RT recipients encounter.