International urology and nephrology · 2026
De novo urothelial carcinoma in kidney transplant recipients: a single-center retrospective cohort study.
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Schmidt Jacob, Lehnert Malte, Lichy Isabel, Goranova Irena, Weinberger Sarah, Jeutner Jonathan, Kurz Lukas, Plage Henning, Schlomm Thorsten, Friedersdorff Frank, Peters Robert, Biernath Nadine, Ralla Bernhard
Аннотация
PURPOSE: To characterize the incidence, clinicopathologic features, treatment patterns, and both oncologic and graft-related outcomes of de novo urothelial carcinoma (UC) in kidney transplant recipients (KTRs) at a large German transplant center.
METHODS: Retrospective single-center cohort of KTRs (2005-2024). 19 patients with post-transplant UC were identified among 4,012 KTRs. We extracted demographics, transplant and tumor characteristics, treatments, graft outcomes, and survival. The standardized incidence ratio (SIR) was calculated using population-based incidence rates, and Kaplan-Meier estimates were used for overall survival (OS), metastasis-free survival (MFS), and graft survival (GS).
RESULTS: UC occurred in 0.47% of KTRs, yielding an SIR of 2.21 (95% confidence interval [CI] 1.33-3.44) compared with the general population. Most tumors were bladder-based (63.2%), but there was a high proportion of upper-tract urothelial carcinoma (UTUC; 31.6%), including graft-involving tumors. Radical surgery was performed in 47.4% of patients, 15.8% received systemic chemotherapy, and intra-vesical therapy was rarely used. Median OS after UC diagnosis was 55 months, with estimated 3- and 5-year OS rates of 70% and 51%, respectively, and 3- and 5-year MFS rates of 73%. Graft failure occurred in 47.4% of patients, and in 21.1% of the total cohort it was directly attributed to UC.
CONCLUSION: Post-transplant UC in KTRs is associated with a more than twofold increased incidence compared with the general population and a disproportionate burden of upper tract and graft-involving tumors. Management must carefully balance oncologic control against preservation of transplant function in a setting where standard intra-vesical and systemic therapies are constrained by immunosuppression. These findings support risk-adapted lifelong urologic surveillance and highlight the need for dedicated treatment strategies tailored to immunosuppressed patients.
METHODS: Retrospective single-center cohort of KTRs (2005-2024). 19 patients with post-transplant UC were identified among 4,012 KTRs. We extracted demographics, transplant and tumor characteristics, treatments, graft outcomes, and survival. The standardized incidence ratio (SIR) was calculated using population-based incidence rates, and Kaplan-Meier estimates were used for overall survival (OS), metastasis-free survival (MFS), and graft survival (GS).
RESULTS: UC occurred in 0.47% of KTRs, yielding an SIR of 2.21 (95% confidence interval [CI] 1.33-3.44) compared with the general population. Most tumors were bladder-based (63.2%), but there was a high proportion of upper-tract urothelial carcinoma (UTUC; 31.6%), including graft-involving tumors. Radical surgery was performed in 47.4% of patients, 15.8% received systemic chemotherapy, and intra-vesical therapy was rarely used. Median OS after UC diagnosis was 55 months, with estimated 3- and 5-year OS rates of 70% and 51%, respectively, and 3- and 5-year MFS rates of 73%. Graft failure occurred in 47.4% of patients, and in 21.1% of the total cohort it was directly attributed to UC.
CONCLUSION: Post-transplant UC in KTRs is associated with a more than twofold increased incidence compared with the general population and a disproportionate burden of upper tract and graft-involving tumors. Management must carefully balance oncologic control against preservation of transplant function in a setting where standard intra-vesical and systemic therapies are constrained by immunosuppression. These findings support risk-adapted lifelong urologic surveillance and highlight the need for dedicated treatment strategies tailored to immunosuppressed patients.