Work

De novo urothelial carcinoma in kidney transplant recipients: a single-center retrospective cohort study

Year: 2026

Type: article

Abstract: 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.

Source: International Urology and Nephrology

DOI: 10.1007/s11255-026-05026-2