Renal transplantation
Outcome
Renal Transplantation in Patients With Balkan Endemic Nephropathy

https://doi.org/10.1016/j.transproceed.2006.11.019Get rights and content

Abstract

Background

Balkan endemic nephropathy (BEN) is a chronic tubulointerstitial disease prevalent in Croatia, Romania, Bulgaria, Bosnia and Herzegovina, and Serbia. In addition to renal disease, an increased incidence of upper urothelial carcinomas (UUCs) has been observed in the foci of BEN. Carcinoma may occur alone or in combination with BEN. Immunosuppression is associated with an increased risk for development of different malignancies. There are no data in the literature about the outcome of patients with BEN after transplantation.

Methods

We performed a retrospective evaluation of the database and review of the charts and pathology reports of 601 renal transplant recipients treated at our institution.

Results

From January 1995 to December 2004, kidney transplantations were performed in nine patients with BEN. One-year graft survival was 100%. A man, who was transplanted in 1997 died 2 years after transplantation with a functioning graft due to disseminated cancer from the pelvis of his own kidney. A female patient developed UCC 2 years after transplantation. They were both treated with a bolus of methylprednisolone before transplantation, because of four HLA-mismatches. A male patient developed UCC in the native and transplanted kidneys. He underwent a native nephroureterectomy with partial nephroureterectomy of transplanted kidney. His graft function was preserved with decreased immunosuppression. Three years later a urinary bladder carcinoma was discovered on a regularly performed multislice computed tomography. One patient developed a skin malignancy. Other patients have had uneventful posttransplantation courses with excellent graft function. Thus, 33.3% of patients with BEN developed UUC, compared with a 0.67% prevalence of urinary tract tumors among transplanted patients with other causes of end-stage renal disease.

Conclusion

Patients with BEN are at increased risk for the development of UCC after transplantation. Regular screening for early detection of malignancy is mandatory. Longer follow-up and results from other transplant centers are needed to further investigate the relationship between BEN and UCC after renal transplantation.

Section snippets

Patients and Methods

We retrospectively analyzed the database to identify renal transplant recipients who were diagnosed to suffer from BEN. These patients were followed prospectively. We reviewed the records of 601 renal transplant recipients who received organs between January 1995 and December 2004. Eighty-five percent of all patients received cadaveric transplant. From January 2006 to August 2006, four additional BEN patients received renal transplants; they were not included in investigation because of the

Results

Between January 1995 and December 2004, renal transplantation was performed in nine patients with BEN. The characteristics of the patients are shown in Table 1. There were three female and six male patients; age at transplantation ranged from 45 to 62 years. Number of HLA mismatches ranged from one to four. Delayed graft function occurred in two patients. One-year graft survival was 100%, with follow-ups ranging from 24 to 106 months.

Patient 1 was treated with hemodialysis for 79 months before

Discussion

Our results demonstrated that patients with BEN display an increased risk for development of UCC. These tumors are generally considered to be rare, but their incidence has increased in the population affected by BEN. The incidence of tumors was four- to 11-fold increased in the endemic area compared with the neighboring control area, and seven- to 60-fold increased when compared to distant nonendemic regions.4, 5, 6, 13, 14 In contrast, transplant recipients may development malignancies as a

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