Experience of transitional cell carcinoma after renal allograft

Purpose: The increased incidence of urologic malignancy, especially transitional cell carcinoma in patient after renal allograft is well known. The aim of this study was to analyze the development of transitional cell carcinoma and its management. Materials and Methods: Of 2,092 patients who underwent renal allograft at Severance hospital between April 1986 and August 2003, 10 (0.48%) had urologic malignancies. The clinical variables collected were patient age, age at renal allograft, cancer diagnosis time since renal allograft, cancer site, TNM stage, pathology and grade, treatment, recurrence and follow up tool. Results: There were 6 men (median age at renal allograft 49.6, median age at cancer diagnosis 57.6) and 4 women (median age at renal allograft 54.5, median age at cancer diagnosis 62.8). There were two adenocarcinoma of prostate patients (0.10%), six transitional cell carcinoma patients (0.29%) and two squamous cell carcinoma of penis patients (0.10%). Sites of transitional cell carcinoma were bladder in five patients, renal pelvis in three patients, ureter in two patients, respectively. As a treatment, nephroureterectomy with bladder cuff resection for transitional cell carcinoma of renal pelvis or ureter, transurethral resection of bladder tumor with mitomycin C intravesical instillation for transitional cell carcinoma of bladder were done. No recurrence or metastasis was observed except transitional cell carcinoma of bladder. In four of five transitional cell carcinoma of bladder patients, multiple recurrences more than three times were observed. Conclusions: In patients after renal allograft, the transitional cell carcinoma always should be highly suspected. Aggressive follow up and management are indicated.