INTRODUCTION AND OBJECTIVES: Renal transplantation is the most optimal method of treating patients with end-stage renal disease (ESRD). As part of their routine malignancy screening, all patients undergo a urine analysis and subsequent urine cytology followed by cystoscopy. Our goal was to determine the incidence of urothelial carcinoma and the significance of urinary atypia in ESRD patients being investigated for transplantation and to establish if it was necessary to perform cystoscopy on all ESRD patients with atypical cytology.

METHODS: We reviewed all patients with ESRD for renal transplantation at our institution from January 2000 to December 2015. A total of 1289 patient charts were retrospectively reviewed.

RESULTS: 8 patients of 1289 (0.62%) patients were found to have urothelial carcinoma (6 males: 2 females), 6 of which were found on pre-transplant surveillance and 2 of which developed subsequent urothelial carcinoma several years after transplant. Mean age of patients who had urothelial carcinoma (65.6±10.1years) was significantly greater than those who did not (50±14.2years; p=0.0018). Of these patients, 67% had a history of smoking but all had microscopic hematuria at presentation. Of the 1289 patients, only 494 ESRD patients had available screening urinary cytology, 180 (36%) had urinary atypia; subsequent cystoscopy revealed cancer in 6 patients (3%). All tumors were treated with TURBT/ fulguration ± mitomycin instillation. Pathology showed papillary non-invasive urothelial carcinoma. No patient required subsequent cystectomy or radiation therapy. All patients who had urothelial carcinoma discovered pre-operatively eventually underwent renal transplant and only one of these patients has had recurrent disease requiring further treatment.

CONCLUSION: The urinary atypia rate is higher in ESRD patients but the incidence of urothelial carcinoma is lower compared to the general population. A large proportion of these patients with urinary atypia consequently undergo invasive workup including cystoscopy. This study suggests that the ESRD population may be over-screened for urothelial carcinoma and calls into question the significance of urinary cytology in this process.

CITATION INFORMATION: Law J, Ali O, Brar H, Luke P, Sener A. Significance of Atypical Cytology in the Evaluation of Patients with End Stage Renal Disease for Transplantation. Am J Transplant. 2017;17 (suppl 3).

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