Transplantation
Volume 98, Issue 1, 2014, Pages 79-87

Outcomes of kidney transplant tourism and risk factors for de novo urothelial carcinoma (Article)

Tsai H.-L. , Chang J.-W.* , Wu T.-H. , King K.-L. , Yang L.-Y. , Chan Y.-J. , Yang A.-H. , Chang F.-P. , Pan C.-C. , Yang W.-C. , Loong C.-C.
  • a Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, School of Medicine, National Yang-Ming University, Taipei, Taiwan
  • b School of Medicine, National Yang-Ming University, Taipei, Taiwan, Division of Pediatric Immunology, Department of Pediatrics, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Taipei, 11217, Taiwan
  • c School of Medicine, National Yang-Ming University, Taipei, Taiwan, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  • d School of Medicine, National Yang-Ming University, Taipei, Taiwan, Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
  • e School of Medicine, National Yang-Ming University, Taipei, Taiwan, Division of Pediatric Immunology, Department of Pediatrics, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Taipei, 11217, Taiwan
  • f School of Medicine, National Yang-Ming University, Taipei, Taiwan, Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  • g School of Medicine, National Yang-Ming University, Taipei, Taiwan, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  • h School of Medicine, National Yang-Ming University, Taipei, Taiwan, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  • i School of Medicine, National Yang-Ming University, Taipei, Taiwan, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  • j School of Medicine, National Yang-Ming University, Taipei, Taiwan, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  • k School of Medicine, National Yang-Ming University, Taipei, Taiwan, Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Taipei, 11217, Taiwan

Abstract

BACKGROUND: To date, the outcomes of transplant tourism have not been reported extensively. In addition, data about the accuracy of urine cytology for the detection and the role of the BK virus (BKV) in the carcinogenesis of urothelial carcinoma (UC) after renal transplantation are lacking. METHODS: Three hundred seven patients who received deceased donor kidney transplants between January 2003 and December 2009 were retrospectively studied. The clinical parameters and outcomes between the domestic and tourist groups were compared. We also investigated the risk factors and role of BKV in the carcinogenesis of de novo UC by quantitative real-time polymerase chain reaction. RESULTS: The subjects in the tourist group were older at transplantation and had a shorter dialysis time before transplantation. There were significantly higher incidence rates of BKV viruria, Pneumocystis jiroveci pneumonia, and malignancy in the tourist group. Graft and patient survival were superior in the domestic group. A total of 43 cancers were identified, and the most common type of malignancy was UC (23 patients, 53.5%). The tourist group had a significantly higher incidence of tumors. The sensitivity and specificity of urine cytology for detecting UC were 73.9% and 94.7%, respectively. Independent predictors of UC included female sex, use of Chinese herbal medicine, and transplant tourism. Only two patients (8.7%) with UC had detectable BKV. CONCLUSIONS: Transplant tourism was a risk factor for infection and de novo malignancy. Urothelial carcinoma was the most common malignancy after kidney transplantation. Regular screening for the early detection of UC by urine cytology or periodic sonographic surveys is mandatory, especially for those at high risk. © 2014 by Lippincott Williams and Wilkins.

Author Keywords

Kidney transplantation Transplant tourism End-stage renal disease Urothelial carcinoma

Index Keywords

Tumor Virus Infections China Pneumocystis pneumonia Kaplan-Meier Estimate DNA, Viral human risk assessment sex difference middle aged priority journal Time Factors Taiwan Humans virus detection Treatment Outcome graft survival male female risk factor Risk Factors herbal medicine Incidence Article Retrospective Studies carcinogenesis major clinical study adult graft recipient carcinoma Kidney Transplantation medical tourism Sex Factors outcome assessment retrospective study quantitative analysis Polyomavirus Infections Urologic Neoplasms disease association transitional cell carcinoma bk virus infection Urothelium BK virus urine cytology Drugs, Chinese Herbal real time polymerase chain reaction
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84903766907&doi=10.1097%2fTP.0000000000000023&partnerID=40&md5=8c6d2e8fb4311ca1f48d5c19dc68acfa
DOI: 10.1097/TP.0000000000000023
ISSN: 00411337
Cited by: 7
Original Language: English