Department of Urology/Transplantation Centre, Klinikum Bremen-Mitte, Bremen, Germany.
J Urol. 2011 Feb;185(2):428-32. doi: 10.1016/j.juro.2010.09.091. Epub 2010 Dec 17.
The development of de novo malignancies is a well-known complication after renal transplantation. With increasing donor and recipient age the risk of post-transplant malignancy including genitourinary cancers is increasing. Thus, urologists have an increasing likelihood of treating these cases. We report our experience with the management of urological de novo malignancies after renal transplantation.
Urological de novo malignancies developed in 29 of 802 patients after renal transplantation between 1988 and 2009. Data were analyzed for tumor incidence, treatment, followup and possible factors contributing to tumor development.
Patients had renal cell carcinoma (12 at a median of 46.5 months after renal transplantation), transitional cell carcinoma (6 bladder cases at 35 months, 2 renal pelvis cases at 37.5 months), carcinoma of the prostate (7 at 69 months) and seminoma (2 at 41.5 months). No treatment related graft losses occurred. Of 3 cases of renal cell carcinoma developing in the graft 2 were treated with nephron sparing surgery.
Urological post-transplant malignancies are an increasing problem for urologists. Regular surveillance after renal transplantation is mandatory to detect early occurrence of de novo malignancies and standard urological treatment principles can be applied. Nonfunctioning native kidneys with suspicious lesions should be removed early. Radical pelvic surgery after renal transplantation and nephron sparing procedures in the graft can be a challenge even for the experienced urologist, and require surgical versatility.
新发恶性肿瘤是肾移植后的已知并发症。随着供体和受者年龄的增加，包括泌尿生殖系统癌症在内的移植后恶性肿瘤的风险也在增加。因此，泌尿科医生治疗这些病例的可能性也在增加。我们报告了我们在肾移植后处理泌尿生殖系统新发恶性肿瘤的经验。
1988 年至 2009 年间，802 例肾移植患者中有 29 例发生了泌尿生殖系统新发恶性肿瘤。对肿瘤发病率、治疗、随访和可能导致肿瘤发展的因素进行了数据分析。
患者患有肾细胞癌（12 例，在肾移植后中位时间为 46.5 个月）、移行细胞癌（膀胱 6 例，35 个月；肾盂 2 例，37.5 个月）、前列腺癌（7 例，69 个月）和精原细胞瘤（2 例，41.5 个月）。无治疗相关移植物丢失。在移植肾中发生的 3 例肾细胞癌中，2 例采用了保留肾单位手术治疗。
泌尿生殖系统移植后恶性肿瘤是泌尿科医生面临的一个日益严重的问题。肾移植后定期进行监测是发现新发恶性肿瘤的必要条件，可以应用标准的泌尿生殖系统治疗原则。对于有可疑病变的无功能固有肾脏，应尽早切除。即使对于经验丰富的泌尿科医生来说，移植后根治性盆腔手术和移植肾保留单位手术也是一个挑战，需要手术的多样性。
