*Purpose: The purpose of the present study was to evaluate the incidence and risk factors of contralateral upper tract urothelial carcinoma (UTUC) after primary radical nephroureterectomy in kidney transplant patients.

*Methods: A total of 56 kidney transplant patients were diagnosed with UTUC between 2001 and 2019. They were compared with 56 matched general population. All patients were treated with radical nephroureterectomy. Clinicopathologic and follow-up data were investigated, including age, gender, pathological grade, immunosuppressant regimen and aristolochic acid. The log-rank test and Cox regression were used to identify the predictor of contralateral UTUC recurrence.

*Results: At a median follow-up time of 65.1 (rang: 7-223) months, 21 patients (37.5%) developed contralateral UTUC. The incidence rate of recurrence was higher than that in control group (p<0.05). In multivariate analysis, the exposure of aristolochic acid was an independent risk factor.

*Conclusions: The incidence rate of contralateral UTUC recurrence in kidney transplant patients was higher, and aristolochic acid exposure was a significant predictor. Our results suggest that prophylactic contralateral nephroureterectomy should be considered in kidney transplant patients with UTUC.

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