Boissier R, Thuret R, Prudhomme T, Verhoest G, Bessede T, Branchereau J, Goujon A, Drouin S, Boutin J-M, Neuzillet Y, Roupret M, Méjean A, Timsit M-O
Comité de transplantation et d'insuffisance renale chronique de l'association française d'urologie (ctafu), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et Transplantation, université Aix-Marseille, hôpital de la Conception, 47, boulevard Baille, 13005 Marseille, France.
Comité de transplantation et d'insuffisance renale chronique de l'association française d'urologie (ctafu), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Lapeyronie, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34070 Montpellier, France.
Prog Urol. 2021 Jan;31(1):31-38. doi: 10.1016/j.purol.2020.04.028.
To propose surgical recommendations for urothelial carcinoma management in kidney transplant recipients and candidates.
A review of the literature (Medline) following a systematic approcah was conducted by the CTAFU regarding the epidemiology, screening, diagnosis and treatment of urothelial carcinoma in kidney transplant recipients and candidates for renal transplantation. References were assessed according to a predefined process to propose recommendations with levels of evidence.
Urothelial carcinomas occur in the renal transplant recipient population with a 3-fold increased incidence as compared with general population. While major risk factors for urothelial carcinomas are similar to those in the general population, aristolochic acid nephropathy and BK virus infection are more frequent risk factors in renal transplant recipients. As compared with general population, NMIBC in the renal transplant recipients are associated with earlier and higher recurrence rate. The safety and efficacy of adjuvant intravesical therapies have been reported in retrospective series. Treatment for localized MIBC in renal transplant recipients is based on radical cystectomy. In the candidate for a kidney transplant with a history of urothelial tumor, it is imperative to perform follow-up cystoscopies according to the recommended frequency, depending on the risk of recurrence and progression of NMIBC and to maintain this follow-up at least every six months up to transplantation whatever the level of risk of recurrence and progression. Based on current data, the present recommendations propose guidelines for waiting period before active wait-listing renal transplant candidates with a history of urothelial carcinoma.
The french recommendations from CTAFU should contribute to improve the management of urothelial carcinoma in renal transplant patients and renal transplant candidates by integrating both oncologic objectives and access to transplantation.
提出肾移植受者及候选者尿路上皮癌管理的手术建议。
CTAFU按照系统方法对文献（Medline）进行回顾，内容涉及肾移植受者及肾移植候选者尿路上皮癌的流行病学、筛查、诊断和治疗。根据预定义流程评估参考文献，以提出具有证据水平的建议。
尿路上皮癌在肾移植受者人群中的发生率比普通人群高3倍。虽然尿路上皮癌的主要危险因素与普通人群相似，但马兜铃酸肾病和BK病毒感染在肾移植受者中是更常见的危险因素。与普通人群相比，肾移植受者中的非肌层浸润性膀胱癌（NMIBC）复发更早且复发率更高。回顾性系列报道了辅助膀胱内治疗的安全性和有效性。肾移植受者局限性肌层浸润性膀胱癌（MIBC）的治疗基于根治性膀胱切除术。对于有尿路上皮肿瘤病史的肾移植候选者，必须根据推荐频率进行随访膀胱镜检查，这取决于NMIBC复发和进展的风险，并且无论复发和进展风险水平如何，在移植前至少每六个月维持这种随访。基于当前数据，本建议提出了有尿路上皮癌病史的肾移植候选者进入积极等待名单前等待期的指导原则。
CTAFU的法国建议应有助于通过整合肿瘤学目标和移植机会来改善肾移植患者及肾移植候选者尿路上皮癌的管理。
