Malignancy of Urinary Tract in Kidney Transplant Recipients—A Narrative Review

TL;DR

This review discusses how kidney transplant recipients are at higher risk for urinary tract cancers due to immunosuppressive therapy and highlights the need for specialized care.

Contribution

The paper provides a comprehensive overview of urinary tract malignancies in kidney transplant recipients, emphasizing collaborative care and research gaps.

Findings

Malignancies are the third most common cause of death in kidney transplant recipients.

Over 90% of malignancies in these patients are de novo, not transmitted with the organ.

Urinary tract malignancies are the most common type in kidney transplant recipients.

Abstract

Cancer has become a more common cause of death in patients after kidney transplantation. Patients receiving immunosuppressive therapy, including those after organ transplantation, are more prone to developing malignancies than the general population. In some patients with a history of malignancy, malignancy recurrence may also occur. Among patients who develop neoplasm after kidney transplantation, urinary tract malignancies are the most common. The diagnosis, treatment, and screening of these malignances may differ from those in the general population. Therefore, close collaboration among medical oncologists, urologists, nephrologists, and surgeons is crucial.

Kidney transplantation is the optimal treatment for end-stage kidney failure. However, after successful kidney transplantation, patients require long-term immunosuppression. Due to immunosuppressive therapy, the development of malignancies is more common in solid organ transplant recipients than in the general population. Because renal transplantation has been performed for many decades—much longer than other solid organ transplants—data on malignancies in kidney allograft recipients are the most comprehensive. Malignancies are the third most common cause of death in kidney allograft recipients, after cardiovascular disease and infections. In kidney allograft recipients, malignancies may develop de novo, be transmitted with the transplanted organ, or arise from previously present but undiagnosed cancers in the recipient. Over 90% of malignancies in renal allograft recipients are de novo. In this review, we first present the epidemiology of malignancies after kidney transplantation. Subsequently, the most common urinary tract malignancies, along with their diagnosis, treatment, and screening, are discussed. We also outline the limitations of the published data, propose research priorities, and identify existing gaps and unmet needs.

Figures