Urothelial carcinoma arising from the transplanted kidney: A single‐center experience and literature review

Bellini, Maria Irene; Gopal, Jeevan Prakash; Hill, Peter; Nicol, David; Gibbons, Norma

doi:10.1111/ctr.13559

Cited by 6 publications

(7 citation statements)

References 42 publications

(43 reference statements)

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“…Post-KTx malignancy is a common cause of death [5,6,47,48,49,50,51] and RCC is the most common solid-organ malignancy in this population [52,53]. Due to the increased risk of RCC among ESRD patients [7,8], the Clinical Practice Guidelines Committee of the AST has suggested RCC screening in ESRD patients on dialysis for longer than 3 years [9,10].…”

Section: Discussionmentioning

confidence: 99%

Incidence and Mortality of Renal Cell Carcinoma after Kidney Transplantation: A Meta-Analysis

Chewcharat

Thongprayoon

Bathini

et al. 2019

JCM

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Background: The incidence and mortality of renal cell carcinoma (RCC) after kidney transplantation (KTx) remain unclear. This study's aims were (1) to investigate the pooled incidence/incidence trends, and (2) to assess the mortality/mortality trends in KTx patients with RCC. Methods: A literature search was conducted using the MEDLINE, EMBASE and Cochrane databases from inception through October 2018. Studies that reported the incidence or mortality of RCC among kidney transplant recipients were included. The pooled incidence and 95% CI were calculated using a random-effect model. The protocol for this meta-analysis is registered with PROSPERO; no. CRD42018108994. Results: A total of 22 observational studies with a total of 320,190 KTx patients were enrolled. Overall, the pooled estimated incidence of RCC after KTx was 0.7% (95% CI: 0.5–0.8%, I2 = 93%). While the pooled estimated incidence of de novo RCC in the native kidney was 0.7% (95% CI: 0.6–0.9%, I2 = 88%), the pooled estimated incidence of RCC in the allograft kidney was 0.2% (95% CI: 0.1–0.4%, I2 = 64%). The pooled estimated mortality rate in KTx recipients with RCC was 15.0% (95% CI: 7.4–28.1%, I2 = 80%) at a mean follow-up time of 42 months after RCC diagnosis. While meta-regression analysis showed a significant negative correlation between year of study and incidence of de novo RCC post-KTx (slopes = −0.05, P = 0.01), there were no significant correlations between the year of study and mortality of patients with RCC (P = 0.50). Egger's regression asymmetry test was performed and showed no publication bias in all analyses. Conclusions: The overall estimated incidence of RCC after KTX was 0.7%. Although there has been a potential decrease in the incidence of RCC post-KTx, mortality in KTx patients with RCC has not decreased over time.

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Section: Discussionmentioning

confidence: 99%

Incidence and Mortality of Renal Cell Carcinoma after Kidney Transplantation: A Meta-Analysis

Chewcharat

Thongprayoon

Bathini

et al. 2019

JCM

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“…In addition to the immunosuppression risk, the role of ADPKD as a risk factor for renal cell carcinoma is well established; in fact a recent review by Yu et al highlights the association of polycystic kidney disease with the risk of liver, colon, and kidney cancer [25]. Our centre policy is to monitor carefully any cystic change at imaging in ADPKD transplanted patients; of note, there is no evidence that there is an advantage in preventing malignancy development in APKD by avoiding the use of calcineurin inhibitors, as immunosuppression alone cannot be accounted as responsible for renal cancer in transplanted patients [21, 26].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Nephrectomy for Adult Polycystic Kidney Disease Does Not Affect the Graft Function of Transplant Patients and Does Not Result in Sensitisation

Bellini

Charalmpidis

Brookes

et al. 2019

BioMed Research International

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Background. Native nephrectomy in Adult Polycystic Kidney Disease (ADPKD) patients is a major operation with controversy related to timing and indications. We present our single centre experience in transplanted patients and future candidates for transplantation. Methods. Retrospective analysis from an anonymised database of bilateral nephrectomies for ADPKD patients. Results were reported as median, range, and percentage. Differences between groups were tested using ANOVA and t-test. Surgery was performed between January 2012 and July 2018. Results. Thirty-three patients underwent bilateral native nephrectomy for APKD. 18 had a functioning kidney transplant (transplant group, 55%) while 15 patients were on dialysis (dialysis group, 45%) at the time of surgery; 8 patients of the latter group (24% of the whole cohort) were eventually transplanted. 53% were males, with median age of 55 years (27-71). Indications to surgery were the following: space (symptoms related to the size of the native kidneys or need to create space for transplantation) (59%), recurrent cyst infection (36%), haematuria (15%), pain (24%), and weight loss associated with cystic alteration on imaging (3%). In the transplant group, postoperative kidney function was not affected; haemoglobin serum levels significantly dropped in the whole cohort: 121 (82-150) g/L, versus 108 (58-154) g/L (p<0.001), with 14 patients being transfused perioperatively. Elevation of anti-HLA antibodies was noted in one female patient on dialysis, with no change in DSA levels and no rejection after transplant for all 26 transplanted patients. Median postoperative length of hospital stay was 9 days (6-71). One patient died (3%) after six months. Median follow-up for the whole cohort was 282 days (13-1834). Histopathological examination revealed incidental renal neoplasms in five cases (15%): 1 pT1a papillary renal cell carcinoma and 4 papillary adenomas. Conclusions. Native nephrectomy for ADPKD could be safely performed in case of refractory symptoms, suspect of cancer or to create space for transplantation. It does not affect graft function or DSA status of transplanted patients or the prospect of transplantation of those on the waiting list.

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“…Donor-related malignancy is relatively rare and can be categorized as donor-transmitted if presenting shortly after transplant or donor-derived if many years later [ 4 – 6 ]. There are several reported cases of donor-related malignancies achieving complete remission after transplant organ resection, immunosuppression withdrawal, and occasionally chemotherapy or radiotherapy [ 7 – 10 ]. Features reported in 36 published allograft upper tract urothelial carcinoma (UTUC) cases include long latency (mean 10 years) from transplant to disease presentation, immunosuppression and BK infection as risk factors, and highly aggressive tumor biology [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…There are several reported cases of donor-related malignancies achieving complete remission after transplant organ resection, immunosuppression withdrawal, and occasionally chemotherapy or radiotherapy [ 7 – 10 ]. Features reported in 36 published allograft upper tract urothelial carcinoma (UTUC) cases include long latency (mean 10 years) from transplant to disease presentation, immunosuppression and BK infection as risk factors, and highly aggressive tumor biology [ 10 ]. Ortega et al described a case of donor-derived UTUC discovered nine years postrenal transplant and complicated by BK viremia six years posttransplant successfully managed with transplant nephrectomy and immunosuppression withdrawal [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Metastatic Urothelial Carcinoma from Transplanted Kidney with Complete Response to an Immune Checkpoint Inhibitor

Chiang

Connor

Inman

et al. 2020

Case Reports in Urology

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Background. Donor-derived malignancy is a rare complication in patients who undergo organ transplant. Approaches to treatment have largely been individualized based on clinical circumstances given the lack of evidence-based guidelines, with therapeutic options ranging from discontinuation of immunosuppression and transplantectomy to the addition of chemotherapy or radiotherapy. Case Presentation. Herein, we describe a 60-year-old woman with metastatic donor-derived upper tract urothelial carcinoma (UTUC) discovered nine years postrenal transplant. Molecular diagnostic studies using polymerase chain reaction amplification of short tandem repeat alleles and HLA tissue typing proved that the urothelial carcinoma originated from donor tissue. She achieved sustained complete remission with transplant nephroureterectomy, retroperitoneal lymphadenectomy, immunosuppression withdrawal, and immunotherapy with pembrolizumab. Routine radiologic surveillance has demonstrated 15-month progression-free survival to date off pembrolizumab, and she is now under consideration for retransplantation. Conclusions. Immunotherapy using checkpoint inhibitors can serve as a novel treatment option for patients in the clinical predicament of having a solid organ transplant and simultaneous metastatic malignancy. In this report, we also discuss the oncogenic potential of BK virus, the use of checkpoint inhibitors in urothelial carcinoma, and the feasibility of retransplant for this patient population.

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Urothelial carcinoma arising from the transplanted kidney: A single‐center experience and literature review

Cited by 6 publications

References 42 publications

Incidence and Mortality of Renal Cell Carcinoma after Kidney Transplantation: A Meta-Analysis

Incidence and Mortality of Renal Cell Carcinoma after Kidney Transplantation: A Meta-Analysis

Bilateral Nephrectomy for Adult Polycystic Kidney Disease Does Not Affect the Graft Function of Transplant Patients and Does Not Result in Sensitisation

Metastatic Urothelial Carcinoma from Transplanted Kidney with Complete Response to an Immune Checkpoint Inhibitor

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