Genitourinary malacoplakia in renal transplant recipients: pathogenic, prognostic and therapeutic considerations

The management of genitourinary malacoplakia in renal transplant recipients has been unsatisfactory previously, as evidenced by an unacceptably high rate of graft loss and mortality. To optimize future management of this problem we studied 2 poorly recognized factors in the pathogenesis and prognosis of genitourinary malacoplakia in transplant recipients: 1) the probable role of azathioprine as the specific immunosuppressive agent responsible for the pathogenesis of malacoplakia, and 2) the importance of the localization of the disease and its impact on the ultimate prognosis. A new therapeutic regimen is suggested, which includes long-term antibiotics combined with an immediate modification of azathioprine therapy and early graft nephrectomy in selected cases with renal parenchymal involvement.