Case report: Ureteral carcinoma after kidney transplant (2008)

Kidney transplant from a 70-year-old donor (20 pack-years, no known or suspected malignancy) to a 71-year-old recipient. Initially slow improvement of kidney function and subsequent rise in creatinie levels. On post-op day 36 nephrostomy catheter was placed and on day 80 placement of pigtail catheter was performed due to continuing (and now complete) proximal ureter stenosis. Additional rejection therapy led to decrease of creatinine levels. Five months after kidney transplantation (KTX) the graft was removed due to malfunction, recurrent urinary tract infection (MDR gram neg), rejection, recipient's other complication (PCP, CMV), insufficient arterial graft perfusion. In the removed graft, low-grade non-invasive papillary urothelial carcinoma was detected. Consequently, the remaining ureter of the donor and the ureterocystic anastomosis was removed. No addtional signs of malignancy was observed at follow up of 12 months in the recipient returning to dialysis without immunosuppression. The recipient of the contralateral donor kidney showed no signs of malignancy at the time of publication. Ureter stenosis at the proximal location in the early period after KTX may be suspicious for obstruction of the ureter by urothelial carcinoma as shown retrospecitvely after graftectomy and proper workup of the removed graft. Early after KTX occuring DISTAL stenosis of the ureter, though, is more likely linked to complications of the ureterovesical anastomosis whereas early PROXIMAL stenosis of the ureter may often be a result of ischemic complication. In contrast LATE ureter stenosis is known to be caused by multiple etiologies including urothelial carcinoma. Upper tract urothelial carcinoma is a rare event (incidence 1/100000/yr) and accounts for 5-7% of all renal tumors. Depending on staging at time of diagnosis in transplant recipients, survival is variable as well as what therapeutic intervention become necessary beyond graft-ureter-ureterocystic anastomosis and discontinued immunosuppression.