Moldoveanu Oana, Baston Cătălin, Sorohan Bogdan, Discălicău Lucas, Mirvald Cristian, Baston Oana Mădălina, Sinescu Ioanel
Department of Urology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Center of Surgical Urology and Kidney Transplantation, Fundeni Clinical Institute, 022328 Bucharest, Romania.
Biomedicines. 2025 May 6;13(5):1118. doi: 10.3390/biomedicines13051118.
: Kidney transplant recipients present a higher risk of developing malignancies than the general population. Malignancies represent the third leading cause of death for kidney transplant recipients. There is an increased risk of developing urothelial carcinoma among kidney transplant recipients, but it is not as high as the risk of renal cell carcinoma, which is the most common urologic malignancy. Although the bladder is the most common location for urothelial carcinoma, urothelial carcinomas of the upper tracts of the native kidneys and the allograft are also reported. The estimated incidence of urothelial carcinomas arising on kidney grafts is 0.019%. We present a case of a kidney transplant recipient who developed non-muscle-invasive bladder cancer 10 years after the transplant. This was successfully treated with TURBT (transurethral resection of the bladder tumor) and BCG (bacillus Calmette-Guerin) instillations. Two years later, this patient developed metastatic urothelial carcinoma of the allograft. Nephroureterectomy of the transplant with bladder preservation after BCG treatment, no systemic chemotherapy, and cessation of immunotherapy were the treatments of choice in this case. Local oncologic control and spontaneous complete regression of pulmonary metastasis were obtained at a 2-year follow-up. With this case, we emphasize the fact that managing urothelial carcinomas in kidney transplant recipients is a provocative challenge for surgeons, nephrologists, and oncologists, as there are no treatment guidelines or protocols.
肾移植受者发生恶性肿瘤的风险高于普通人群。恶性肿瘤是肾移植受者的第三大死亡原因。肾移植受者发生尿路上皮癌的风险增加，但不如肾细胞癌的风险高，肾细胞癌是最常见的泌尿系统恶性肿瘤。尽管膀胱是尿路上皮癌最常见的发病部位，但也有关于自体肾和移植肾上部尿路上皮癌的报道。肾移植后发生尿路上皮癌的估计发病率为0.019%。我们报告一例肾移植受者，在移植后10年发生非肌层浸润性膀胱癌。经经尿道膀胱肿瘤切除术（TURBT）和卡介苗（BCG）膀胱灌注成功治疗。两年后，该患者发生移植肾转移性尿路上皮癌。本例的治疗选择是在卡介苗治疗后保留膀胱行移植肾输尿管切除术，不进行全身化疗，并停止免疫治疗。在2年的随访中实现了局部肿瘤控制和肺转移的自发完全消退。通过这个病例，我们强调了一个事实，即对于外科医生、肾病学家和肿瘤学家来说，处理肾移植受者的尿路上皮癌是一个具有挑战性的难题，因为目前尚无治疗指南或方案。
