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      Neoplasias urológicas de novo en pacientes trasplantados renales: experiencia en 1.751 pacientes Translated title: De novo urological neoplasms in kidney transplant patients: Experience in 1,751 patients

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          Abstract

          Introducción: el tratamiento inmunosupresor en pacientes que reciben un trasplante renal favorece el desarrollo de neoplasias. La prevalencia de neoplasias en trasplantados es de 4 a 5 veces mayor que en la población general. Además se sabe que los tumores en trasplantados se comportan con una mayor agresividad. Objetivo: evaluar mediante un análisis descriptivo las neoplasias de novo urológicas en pacientes trasplantados renales y analizar la supervivencia de los mismos. Material y métodos: estudio retrospectivo desde enero de 1980 hasta diciembre de 2006 sobre 1.751 pacientes trasplantados. Se excluyeron aquellos en los que la neoplasia apareció durante el primer año tras el trasplante. Se consideraron las principales variables: sexo, edad al trasplante, edad al diagnóstico de la neoplasia, localización, estadio clínico, tratamiento y evolución. Para el análisis estadístico univariante se utilizó la prueba de Chi cuadrado. La supervivencia fue evaluada mediante el método de Kaplan Meier. Resultados: se diagnosticaron 29 (1,6%) neoplasias de novo en un total de 1.751 trasplantados, con una mediana de seguimiento de 35,28 meses (2-121) desde el diagnóstico de la neoplasia. La distribución por sexos fue de 24 varones (82%) frente a 5 mujeres (18%). La mediana de edad en el momento del trasplante fue de 50,8 (17-70) años y la mediana de edad en el diagnóstico de neoplasia fue de 56,4 (19-79) años. Se diagnosticó a 11 pacientes (38%) de cáncer próstata, a 7 pacientes (24%) de neoplasias de vejiga a 4 (60%) no músculo invasivas y a tres (40%) de tumor músculo invasivo y en 6 pacientes (20%) se diagnosticó un adenocarcinoma renal sobre el riñón primitivo. En 5 sujetos (18%) se detectó una neoplasia del riñón trasplantado. La mediana de supervivencia fue de 75 meses para tumores de vejiga, 82 meses en el cáncer de próstata, 59 meses en el riñón primitivo y 86 meses para el riñón trasplantado. Conclusiones: en nuestra serie las neoplasias urológicas de novo en trasplantados renales son más frecuentes en varones. El cáncer de próstata es la neoplasia más frecuente y el adenocarcinoma renal del riñón primitivo es la de menor supervivencia.

          Translated abstract

          Introduction: Immunosuppressive treatment promotes development of neoplasms in kidney transplant patients. Cancer prevalence in these patients is 4 to 5 times higher as compared to the general population. Tumors are also known to behave more aggressively in transplant patients. Objective: To perform a descriptive analysis of de novo urological tumors in kidney transplant patients and to analyze patient survival. Materials and methods: A retrospective study was conducted in 1751 transplant patients from January 1980 to December 2006. Patients in whom the tumor occurred in the first year after transplantation were excluded. The primary variables considered included sex, age at transplant, age at cancer diagnosis, site, clinical stage, treatment, and outcome. A Chi-square test was used for univariate statistical analysis. Survival was assessed using the Kaplan-Meier method. Results: Twenty-nine de novo tumors (1.6%) were diagnosed in the 1751 transplanted patients, with a median follow-up of 35.28 months (2-121) from tumor diagnosis. Tumors were found in 24 males (82%) and 5 females (18%). Median age at transplantation was 50.8 (17-70) years, and median age at tumor diagnosis was 56.4 (19-79) years. Eleven patients (38%) were diagnosed with prostate cancer, seven (24%) with bladder tumors, 4 (60%) with non-muscle invasive tumors, and 3 (40%) with muscle invasive tumors. A renal adenocarcinoma in the primitive kidney was diagnosed in 6 patients (20%). Five patients (18%) were detected a tumor in the transplanted kidney. Median survival was 75 months for patients with bladder tumors, 82 months for prostate cancer, 59 months for tumors in the native kidney, and 86 months for graft tumors. Conclusions: In our series, de novo urological tumors in kidney transplant recipients were more common in males. Prostate cancer is the most common tumor and renal cell carcinoma of the native kidney has the worst survival rate.

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          Most cited references 73

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          Cancer risk after renal transplantation in the Nordic countries, 1964-1986.

          The theory that cancer may arise under conditions of reduced immune capacity is supported by observations of humans with immune deficiencies such as occur following organ transplants. However, no study on humans has been done in which the reference population was the same as that in which the cancer cases arose and in which there was a sufficiently long period of follow-up. Information on 5,692 Nordic recipients of renal transplants in 1964-1982 was linked with the national cancer registries (1964-1986) and population registries. Person-years at risk were calculated from the date of first transplantation until death or the end of the study period and were multiplied by the appropriate age- and calender-specific incidence rates to obtain the expected numbers of cancers. Standardized incidence ratios (SIR) were calculated after stratification by a number of recorded variables. Altogether, 32,392 person-years were accrued, and 471 cancers occurred, yielding overall SIR of 4.6 (95% CI, 4.0 to 5.2) for males and 4.5 (95% CI, 4.0 to 5.2) for females. Significant overall 2- to 5-fold excess risks in both sexes were seen for cancers of the colon, larynx, lung and bladder, and in men also for cancers of the prostate and testis. Notably high risks, 10-fold to 30-fold above expectation, were associated with cancers of the lip, skin (non-melanoma), kidney and endocrine glands, also with non-Hodgkin's lymphoma, and in women also with cancers of the cervix and vulva-vagina. Among a number of donor and recipient variables studied, including tissue types and compatibility (ABO, HLA, DR), age below 45 years at the time of transplantation was the most important determinant for increased risk at most sites. Kidney transplantation increases the risk of cancer in the short and in the long term, consistent with the theory that an impaired immune system allows carcinogenic factors to act. The tumor risk is small in comparison with the benefits of transplants, but patients should be followed up for signs of cancer.
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            Cancer risk in patients on dialysis and after renal transplantation.

            The increased risk of cancer in patients who have had kidney transplants has mainly been attributed to immunosuppressive therapy; however, the prior period of uraemia and dialysis has also been postulated as a cofactor. We analysed cancer risk retrospectively in a cohort of 4178 patients undergoing renal replacement therapy, of whom 3592 were treated with dialysis alone and 1821 later had transplants. We found that excess cancer risk in such patients occurred after transplantation and not during dialysis.
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              Primary kidney tumors before and after renal transplantation.

               I Penn (1995)
              Three groups of patients were reviewed. Primary carcinomas were found in donors kidneys of 47 recipients. In 30 instances a tumor was present at harvesting. When a neoplasm was removed immediately pretransplantation or early posttransplantation there were no recurrences in 14 recipients. In another two instances, a tumor was not removed or was incompletely excised pretransplantation and both recipients died of metastases. Fourteen other patients received kidneys from donors in whom the opposite kidney had a malignancy. Thirteen remained tumor-free and one had allograft nephrectomy for rejection 3 months posttransplantation when a carcinoma was found. In 17 recipients an allograft neoplasm was not recognized at harvesting. In 9 it was discovered at graft nephrectomy an average of 3 months posttransplantation. In a tenth patient a hypoechogenic area, found on routine posttransplant ultrasonography, progressively increased in size and proved to be malignant. Another 7 patients developed metastases from renal carcinomas an average of 12 months posttransplantation. Preexisting carcinomas were found in 350 recipients. Seventy-one patients with incidentally discovered tumors had no recurrences no matter when nephrectomy was performed in relationship to transplantation. Of 279 patients with symptomatic renal tumors, 70 (25%) had recurrences, 63% of which occurred in patients treated < or = 2 years pretransplantation. De novo cancers were found posttransplantation in 256 recipients. Renal carcinomas were 4.6% of posttransplant cancers compared with 3% of tumors in the general population. In 222 patients their own diseased kidneys were involved, in 24 tumors occurred in the allograft, and in 10 cases the site was not stated. Development of neoplasia seemed to be related not to the immunosuppressive therapy but to the underlying cause of renal failure, especially analgesic nephropathy. A disproportionate number of carcinomas (15%) involved the renal pelvis, most likely because of prior analgesic abuse.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                aue
                Actas Urológicas Españolas
                Actas Urol Esp
                Asociación Española de Urología (, , Spain )
                0210-4806
                January 2010
                : 34
                : 1
                : 88-94
                Affiliations
                Valencia orgnameHospital Universitario La Fe orgdiv1Servicio de Urología España
                Article
                S0210-48062010000100015
                10.1016/S0210-4806(10)70015-2

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 46, Pages: 7
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                Survival, Trasplante, Neoplasias, Supervivencia, Transplant, Tumors

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