ABSTRACT
Objective To summarize the clinical characteristics,diagnosis and treatment of malignant tumor after renal transplantation.Methods The clinical data of 2106 renal transplants in 1945 patients undertaken in our hospital from September 1978 to December 2009 was retrospectively studied.Results Of these 1945 patients, 39 cases were diagnosed as having malignant tumor (incidence: 2.0 ％).The interval between transplantation and clinical diagnosis ranged from 8 to 124 months with a median of 57.0 months.Among the 39 cases of malignancy, there were 22 urinary system carcinomas, 8 digestive system carcinomas,2 lung cancers,2 breast cancers,2 lymphomas,1 dura small cell carcinoma,1 pleura poorly differentiated carcinoma and 1 metastatic carcinoma of liver with unknown primary tumor. Surgery was conducted in 28 patients,of which 16 were survived but the other 12 patients died of metastasis ranged from 3 months to 96 months (median,33 months) after operation.11 cases without operation died within from 3 d to 36 months (median,5 months) after diagnosis.Conclusions The incidence of malignant tumors in renal transplant recipients increased markedly.The most common type of the malignant tumors is urinary system carcinoma.The key measure of success in treating malignancy after renal transplantation is early diagnosis and surgical resection.
ABSTRACT
Objective To analyze the epidemiographic features of urological de novo malignant tumor in kidney transplant recipients in the General Hospital of Jinan Military Command.Methods The clinical data of 1945 patients who received kidney transplantation between September 1978 and December 2009 were retrospectively studied.Among 1945 recipients,22 cases were diagnosed as having urological de novo malignant tumors ( incidence:1.13％ ),including renal papillary adencaicinoma (n =1 ),papillary renal cell carcinoma (n =1 ),renal hemangiosarcoma (n =1 ) ; pelvic transitional cell carcinoma (TCC) (n =1 ),pelvic and ureter TCC (n =6),ureter TCC (n =7),pelvic and ureter and urinal bladder TCC (n =1 ),4 cases of bladder malignant tumors (including 3 cases of bladder TCC and 1 case of borderline bladder tumor).Of the 22 cases,17 had a main clinical manifestation of gross hematuria and 2 had microscopic hematuria,and the rest 3 had no obvious symptom.The average age at diagnosis of these 22 cases was 54.3 ± 12.3 years,with a mean time of 53 months after kidney transplantation.Ten cases received immunosuppressive treatment by using cyclosporine A (CsA) + azathioprine (Aza) + prednisone (Pred),while the remaining 12 received CsA + MMF + Pred.Surgical treatment was carried out in all cases:radical nephrectomy was conducted for 3 cases of renal carcinoma; total resection of kidney,ureter and sleeve-shaped resection of bladder in affected side were conducted for the 15 cases of pelvis or ureter carcinoma; for the 4 cases of bladder carcinoma,transurethral resection of bladder tumor was conducted for 3 cases while partial cystectomy was conducted for the other one case.Results During a follow-up period of 2 to 97 months,there were 9 deaths 6 to 97 months after toumorectomy.One died of bone metastasis,one pulmonary metastasis,two brain metastasis,two hepatic metastasis,and three extensive metastatic tumor soon after the diagnosis.Thirteen patients survived through the follow-up,with the longest survival time being 92 months in one patient with urinary bladder tumor.Four patients survived longer than 4 years,and 5 cases longer than 1 year.Conclusion Urological de novo malignant tumor is an important complication after renal transplantation with a main clinical manifestation of painless gross hematuria,and surgical resection is the most important treatment.
ABSTRACT
BACKGROUND: Ureteral obstruction is mainly caused by surgical technic, ischemic, and peripheral lesion compression as well as rejection; in particular, the surgical technic factor is the most important. How to effectively reduce ureteral complications following renal transplantation is significant for prompt diagnosis and clinical treatment.OBJECTIVE: To retrospectively analyze the diagnosis of 23 cases with ureteral complications following renal transplantation, and to summarize pathogeny and preventing management.METHODS: The retrospective analysis was conducted on 23 (1.98%) out of 1 160 cases with ureteral complications following renal transplantation who were selected from General Hospital of Jinan Military Area Command of Chinese PLA from January 1998 to December 2008. In 924 cases of renal transplantation with cadaver kidneys, ureteral stenosis occurred in 18 cases (1.95%), while in 236 cases with relative kidneys, ureteral stenosis occurred in 5 cases (2.12%). A total of 17 cases were performed with ureterovesicostomy; 2 with uretero-autoallergic anastomosis of ureter; 1 with cutaneous ureterostomy; 1 with ureteral liberation, resetting ureteric branch stand; 1 with saccule dilation; 1 with retrograde ureteric branch stand under cystoscope. Type-B ultrasonic examination was re-checked to determine pyeloureterectasis following treating ureteral complications.RESULTS AND CONCLUSION: Of the 23 cases, stenosis of ureterovesical junction occurred in 19 cases, necrosis of the ureter on 2 cases, and twisting of ureter graft on 2 cases. Following up was performed after treatment for 3-98 months. In 20 cases, renal pelvis and urinary bladder of transplanted kidney were smooth, and function was recovered remarkably. At 4 days after surgery, serum creatinine level was decreased, and no recurrence was rechecked postoperatively. One patient had skin stoma for 8 years at least postoperatively, and the renal function was still normal. The skin stoma was replaced regularly. Therapeutic effect was poor in a patient with distension and 1 with detaining ureteric branch stand, and patients still had stricture of ureter,which was treated by a surgery. The results demonstrated that the etiology of ureteral obstruction after kidney transplantation was complex, and stenosis of ureterovesical junction was most common. Most of obstruction request surgical management. The graft function and the long-term graft survival were not affected by a correctly treated ureteral obstruction.