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Post Renal Transplant De Novo Urothelial Carcinoma in Graft Kidneys: A Mini Review

Hansen Lam, Qiusheng Si

Urothelial Carcinoma is any of several types of cancer arising from the tissues of the urinary bladder. Symptoms include blood in the urine, pain with urination, and low back pain. It is caused when epithelial cells that line the bladder become malignant.

Risk factors for Urothelial Carcinoma include smoking, family history, prior radiation therapy, frequent bladder infections, and exposure to certain chemicals. The most common type is transitional cell carcinoma. Other types include squamous cell carcinoma and adenocarcinoma. Diagnosis is typically by cystoscopy with tissue biopsies. Staging of the cancer is determined by transurethral resection and medical imaging.

Specifically, regarding Urothelial Carcinoma (UC), renal transplant recipients have shown a 3-fold increase in rates of De Novo urothelial carcinoma, compared to non-transplant patients. Most of these cases have occurred in the bladder (76%-100%), followed by native kidneys and ureters (8%-24%), with rare cases occurring in the graft kidney (0%-4%). Furthermore, in these rare cases of De Novo donor derived post renal transplant UC, studies have shown a high percentage of these tumors presenting as high grade and at least T2 stage. Rare studies have classified tumors that have occurred or included organs downstream of the graft kidney as donor derived using molecular techniques which include karyotype analysis (XY chromosome studies) and short tandem repeat studies. Donor derived UC remains an important tumor to further characterize, as existing literature suggests that they may have an increased tendency to present at higher grade and stage than another post-transplant UC. We aim to provide a brief review of the literature.