Clinical Analysis Of Urological Transitional Cell Carcinoma In Kidney Transplant Recipients(a Report Of 10 Cases)

The malignancies after renal transplantation include post-transplantation neoplasia,tumor recurrence after radical resection in recipients,and tumor metastasis from donors to recipients.Malignancy is an important complication because of long-term application of immunosuppressive agents.Because of the cumulative effect of a variety of those factors such as the new and strong immunosuppressive agents and the long survival of the recipients,the occurrence rate of malignancies in allograft recipients is growing.Now it becomes one of the most important issues.And because of the long-term immunosuppressive therapy,the recipients became vulnerable to micro-environment disorder with low immunity and a poor tolerability to trauma(surgery or stress),and with slow wound healing ability.So we have a higher requirement for minimally invasive surgery.With the improvement of operation equipments,and the skilled and proficient operators,laparoscopic surgery should be first-choice for the operations of radical resection of urological tumors with detailed preoperative evaluation.We analysis the clinical data of the 10 cases in order to investigate the etiology,characteristics and effective therapy of urological malignancies in renal transplant recipients in a single center,and to emphasize the necessity of regular tumor screening after renal transplantation.Methods:A retrospective analysis of the clinical data was made on 10 cases of urological malignancies after renal transplantation in a single center,and summarise the experiences of diagnosis and therapy.Results:Of all the renal transplant recipients from Jan.1998 to Dec.2008 in Jilin University,10 cases occurred urological malignancies.Triple immunosuppresion agents were used for these cases,including 5 cases of FK506 + MMF + Pred,and 5 cases of CsA + MMF + Pred.Among these cases,4 of them had a longterm application of aristolochic acid(including "Guanxin Suhe Wan","Longdan xiegan Pills" and other proprietary Chinese medicines) more than 2 years before the transplantation,accounting for 40%.And they undergone urological malignancies 1-72 months(with a average of 37 months) after the transplantation,and the admission manifestation includes six cases of gross hematuria,one case of pain in the kidney area,one case of persistant positive occult blood in urine,and two cases through physical examinations using ultrasound and cystoscopy.With the diagnosis of cystoscopy,endoscopy biopsy,ureteral CT,and MRU,the cases including one case of carcinoma of renal pelvis,two cases of ureter and pelvic carcinoma,one case of ureter carcinoma,1case of ureter and baldder carcinoma,and five cases of simple transitional cell carcinoma of bladder.Corresponding surgical operations were performed,including five cases of TURBt,five cases of laparoscopic radical resection of renal and ureter,with little amount of hemorrhage during the operations,and without perioperative complications such as fistula,decubitus, infection of the incision,intestinal obstruction or paralysis,et al.And the incision wound healed in 7-15 days.Pathology results are transitional cell carcinoma (TCC),including two cases of gradeâ… ,five cases of gradeâ…¡,three cases of gradeâ…¢,and one case with the coexistence of adenocarcinoma of the pelvis and transitional cell carcinoma of ureter and bladder.Now these cases have a follow-up for 1 month -45 months,all survived.One of these cases got bronchial lavage cytology and found malignant cells,and was diagnosed as adenocarcinoma pulmonary metastases.One case of renal pelvis cancer recurrence,one cases of ureteral cancer recurrence,two cases of.bladder cancer recurrence.Conclusion:Immunosuppression therapy results in the weakening of immunologic surveillance function,which lead to mutation,aberration and carcinogenesis.The immunological status of patients after renal transplantation should be assessed regularly.Urological malignancies,especially TCC,has a high occurrence rate in renal allograft recipients.A long-term application of some Chinese Herbs which contain Aristolochic acid may be related to the occurrence of urinary tract malignancies.The dialysis time before the transplantation of the uremic patients may be positively correlated to the urological malignancies.Laparoscopic combined with cystoscopic surgery has many advantages,including small incisions wound,less hemorrhage and faster restoration,and less perioperative complications.Because of these,laparoscopic combined with cystoscopy surgery may be the first choice for tumor resection. Tumor screening should be made after renal transplantation,especially with manifestation of hematuria or persistant positive occult blood in urine.These should be considered a significant sign in assessing the potential occurrence of malignancies.So it is recommended to conduct regular and strict tumor screening among the allograft recipients,using the ultrasound,detection of malignant cells in urine,CT as well as MRU for a early detection and therapy.