Objective: To analysis the clinical character of renal transplant (RTx) recipients with bilateral native upper urinary transitional cell carcinoma.
Methods: The clinical data of 7 cases of transitional cell carcinoma in 2236 RTx recipients who underwent non-synchronous native bilateral nephroureterectomy (BNU) for 14 case-times were retrospectively analyzed.
Results: The mean time between RTx and diagnosis of TCC was 49.7 months (24 - 96 months). The mean interval between 2 upper urinary tract operations was 14.0 months (2 - 36 months). All specimens obtained in the 14 operations were TCC-positive. The TCC location involved pure native pelvis (n = 2), pure native ureter (n = 4), and pelvis combined with ureter (n = 8). The TCC pathological grades include G(1)-G(2) (n = 7), G3 (n = 6), and cancer in situ (n = 1). The TCC stage status included pTIS (n = 1), pT(1) N(0)M(0) (n = 4), pT(2)N(0)M(0) (n = 6), pT(3)N(0)M(0) (n = 2), and pT(4)N(2)M(1) (n = 1). Five patients were observed to have TCC in bladder. Each patient underwent more then 2 times of transurethral resection of bladder tumor (TUR-Bt). The bladder TCC was at G(2)-G(3) with deep of superficial muscle involvement. Metastasis was found in skin, soft tissue, and costal bone of lumbar in one patient. The blood creatinine level of the 7 patients, representing the graft's function, was 120 micromol/L (97 - 161 micromol/L). The patients were followed up for 2 - 48 months, all patients survived.
Conclusion: TCC after RTx has multiple sources and is invasive. Non-synchronous prophylactic native BNU with removal of bladder cuffs should be considered for those RTx recipients having multiple urinary tract malignancy in native upper urinary tract and bladder.