腎移植術後原有腎腎水腫與上泌尿道泌尿上皮癌之相關性

何承儒、王紹全、陳文榮、謝佐宜、宋文瑋、陳順郎

中山醫學大學附設醫院 泌尿科

Native hydronephrosis after kidney transplantation relates to upper tract urothelial carcinoma: a single center study

Cheng-Ju Ho, Shao-Chuan Wang, Wen-Jung Chen, Tzuo-Yi Hsieh, Wen-Wei Sung, Sung-Lang Chen

Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan

Purpose:

 High incidence of urothelial carcinoma after kidney transplantation (KT) in Taiwan has been reported. We investigate the potential correlation between hydronephrosis and upper tract urothelial carcinoma (UTUC).

Materials and Methods:

From 2003 to 2018, total 1005 received KT patients who followed up at Chung Shan Medical University Hospital (CSMUH) and 67 later diagnosed UTUC patients were enrolled in this retrospective study. Cox proportional hazards models were conducted for multivariate analysis. Kaplan-Meier analysis for UTUC-free survival status, and log-rank test for curves statistical comparisons.

Results:

Average time from KT to UTUC was 7.53 years. There was significant difference in gender with female predominance in UTUC patients (73.1% versus 26.9%). In UTUC group, native hydronephrosis occurred more often compared with non-UTUC group (68.7% versus 4.8%, respectively, p<0.001). Graft kidney hydronephrosis showed no significant difference with UTUC (20.9 versus 23.3%, p=0.652). In multivariate analysis, without native hydronephrosis presented significant factor with a hazard ratio of 0.071(95% CI, 0.040-1.126; p<0.001). The cumulative UTUC-free survival rates were significantly higher than no hydronephrosis group in Kaplan-Meier analysis.

Conclusions:

Native hydronephrosis is significantly associated with de novo UTUC in post KT recipients in Taiwan, and it is clinical applicable for detection of UTUC. Prophylactic nephroureterectomy is a considerable option for post KT recipients with native hydronephrosis in Taiwan.