High Incidence of Transitional Cell Carcinoma in Kidney Transplant Recipients in Eastern Taiwan

Objective: A higher incidence of urinary tract transitional cell carcinoma (TCC) has been reported in both long-term hemodialysis patients and kidney transplant (KTX) recipients in Taiwan than in other countries. Herein, we report a high incidence of urinary tract malignancy, especially TCC, in KTX recipients in eastern Taiwan. Patients and Methods: We retrospectively reviewed the medical records, clinical data, and outcomes of 102 KTX recipients in Tzu Chi General Hospital from 1992 to 2008. Overall graft and patient survival, incidence of posttransplant malignancy, and cumulative incidence of TCC after KTX were investigated. Results: During a mean follow-up of 45.5 ± 38.5 months after KTX, 12 malignancies were diagnosed in nine recipients. The incidence of post-transplant malignancy in all recipients was 8.2%. TCC was diagnosed in four patients, and all these patients presented with painless gross hematuria and hydronephrosis. Three patients had tumor involvement in the upper urinary tract. TCC occurred at a mean of 56 ± 70.7 months after KTX, and the cumulative incidence of TCC was 4.7% in the first 3 years after transplant. Only one patient with triple cancer died of disseminated cholangiocarcinoma of the distal common bile duct during a mean follow-up of 15.8 ± 9.5 months after surgical treatment of TCC. Conclusion: KTX recipients are at extremely high risk of TCC in eastern Taiwan, with an incidence of 3.9%. The cardinal signs of posttransplant TCC are painless gross hematuria and hydronephrosis of the native kidney. Careful, timely urological screening in KTX recipients warrants early diagnosis and good prognosis after aggressive surgical management.