Single center series (2 cases): Urothelial carcinoma

Status: 
Ready to upload
Record number: 
2029
MPHO Type: 
Estimated frequency: 
Most recent risk assessment for urothelial carcinoma (Council of Europe, 2018): No literature exists regarding newly diagnosed urothelial cancer and organ donation. Therefore, the highest caution is recommended and the advice of a urologist may be sought in assessing the individual donor tumour transmission risk. National recommendations should be followed since they vary in accepting these tumours. In the case of patients with a history of urothelial carcinoma, it must be remembered that these tumors tend to be multicentric and can recur. Kidney transplantation is considered to be associated with an increased risk but the extent of this has not been classified. Similarly, potential donors with a past history of urothelial carcinoma and a disease free interval of at least 5 years should be assessed based on estimate of the probability of cure. No specific recommendations are available from the literature.
Time to detection: 
Patient 1: 6 years; Patient 2: 7 years
Alerting signals, symptoms, evidence of occurrence: 
Patient 1: Worsening shortness of breath and edema; ultrasound showed pelvocalyceal dilatation, hydrometer and a mid-ureteral echogenic focus. Patient 2: Elevated creatinine, acute hydronephrosis and recurrent urinary infections.
Demonstration of imputability or root cause: 
Localization of tumors to allograft ureter segments.
Imputability grade: 
Not Assessable
Groups audience: 
Suggest new keywords: 
Single center series
Malignancy
Deceased donor
Kidney transplant
Urothelial (transitional) cell carcinoma
Living donor
Suggest references: 
Bellini MI, Gopal JP, Hill P, Nicol D, Gibbons N. Urothelial carcinoma arising from the transplanted kidney: A single-center experience and literature review. Clin Transplant. 2019;33(6):e13559.
Note: 
Carl-ludwig: agree to Michael, added estimated freuncy text from guide.
Expert comments for publication: 
Given the long duration between transplant and tumor, the authors conclude that these tumors represent post-transplant processes of malignant transformation that occur in allograft tissue, rather than tumors transmitted at the time of transplant. We agree with this and consider these patients to have "donor-derived", rather than "donor-transmitted", tumors. They further point out that the mean occurrence time of this problem is 10 years posttransplant. Nevertheless, they include a Table of 36 previously reported cases in addition to their own, and in occasional cases the tumors were discovered within the first posttransplant year, suggesting that they had been transmitted at the time of transplant. The authors also discuss nephroureterectomy with withdrawal of immunosuppression as the only realistic therapeutic option. Interestingly, patient 1 received a living donor transplant from her husband who was a chronic smoker. Although she developed urothelial carcinoma, he remained free of tumor. The authors suggest that immunosuppression may play a role in facilitating cancer progression in such cases.