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Background <p>The incidence of upper tract urothelial carcinoma (UTUC) is significantly elevated in kidney transplant (KT) recipients, yet the optimal surgical strategy—unilateral radical nephroureterectomy (URNU) versus bilateral radical nephroureterectomy (BRNU)—remains debated, and prognostic comparisons between KT recipients undergoing URNU and non-transplant (NKT) patients are lacking.</p> Methods <p>This retrospective study analyzed KT recipients with native-system UTUC treated at a single institution (2001–2023). Patients were stratified into BRNU or URNU groups. Propensity score matching (PSM, 1:2) was performed between KT recipients who underwent URNU and NKT patients. Survival outcomes including overall survival (OS), cancer-specific survival (CSS), intravesical recurrence-free survival (IVRFS), disease-free survival (DFS), contralateral recurrence-free survival (CRFS), and progression-free survival (PFS) were compared using Kaplan–Meier and log-rank tests.</p> Results <p>Among KT patients, the BRNU group exhibited significantly better OS (<i>p</i> = 0.01), CSS (<i>p</i> = 0.02), DFS (<i>p</i> &lt; 0.001), and PFS (<i>p</i> &lt; 0.001) than the URNU group, despite longer operative time. In unilateral UTUC patients, BRNU still demonstrated superior DFS and PFS (both <i>p</i> &lt; 0.001). After PSM, survival outcomes did not differ significantly between the URNU-KT and NKT groups across all indices (OS, CSS, IVRFS, DFS, CRFS, PFS; all <i>p</i> &gt; 0.05). The 5-year survival rates were 70.0% in the KT (URNU) group and 65.0% in the NKT group.</p> Conclusion <p>BRNU provides significant survival advantages over URNU in KT recipients with UTUC. After 1:2 PSM of patients treated with URNU, KT patients achieved comparable survival to NKT patients, underscoring that standardized management, including appropriate surgical selection and vigilant surveillance, can yield favorable prognoses in this population.</p>

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Long-term outcomes of upper tract urothelial carcinoma in kidney transplant recipients: efficacy of bilateral radical nephroureterectomy and prognostic comparison of unilateral nephroureterectomy with non-transplant patients

  • 期刊论文

  • 发表日期：

    2026年6月16日

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  • Xinji Yang,
  • Qiming Zhang,
  • Lulin Ma,
  • Shudong Zhang,
  • Xiaofei Hou

摘要

Background

The incidence of upper tract urothelial carcinoma (UTUC) is significantly elevated in kidney transplant (KT) recipients, yet the optimal surgical strategy—unilateral radical nephroureterectomy (URNU) versus bilateral radical nephroureterectomy (BRNU)—remains debated, and prognostic comparisons between KT recipients undergoing URNU and non-transplant (NKT) patients are lacking.

Methods

This retrospective study analyzed KT recipients with native-system UTUC treated at a single institution (2001–2023). Patients were stratified into BRNU or URNU groups. Propensity score matching (PSM, 1:2) was performed between KT recipients who underwent URNU and NKT patients. Survival outcomes including overall survival (OS), cancer-specific survival (CSS), intravesical recurrence-free survival (IVRFS), disease-free survival (DFS), contralateral recurrence-free survival (CRFS), and progression-free survival (PFS) were compared using Kaplan–Meier and log-rank tests.

Results

Among KT patients, the BRNU group exhibited significantly better OS (p = 0.01), CSS (p = 0.02), DFS (p < 0.001), and PFS (p < 0.001) than the URNU group, despite longer operative time. In unilateral UTUC patients, BRNU still demonstrated superior DFS and PFS (both p < 0.001). After PSM, survival outcomes did not differ significantly between the URNU-KT and NKT groups across all indices (OS, CSS, IVRFS, DFS, CRFS, PFS; all p > 0.05). The 5-year survival rates were 70.0% in the KT (URNU) group and 65.0% in the NKT group.

Conclusion

BRNU provides significant survival advantages over URNU in KT recipients with UTUC. After 1:2 PSM of patients treated with URNU, KT patients achieved comparable survival to NKT patients, underscoring that standardized management, including appropriate surgical selection and vigilant surveillance, can yield favorable prognoses in this population.