Purpose. Transitional cell carcinoma (TCC) affecting the graft after renal transplantation is a very infrequent way of presentation of this tumor. Our aim is to present our single institution experience with 2 cases, as well as to perform a review of the literature about this tumor after the transplant. Materials and Methods. TCC of the graft developed in 2 of 1365 patients from 1977 to 2010, both cases in women. Data were analyzed for incidence, clinical presentation, treatment, and outcomes. Results. Both cases occurred in 2 mid-age women and resulted to be high grade and locally advanced TCCs, representing an incidence of 0,14% (2/1365). Clinical presentation was urinary obstruction for the first case and incidental ultrasound finding for the second. Preoperative staging was made with CT, cytology, pyelography, ureterorenoscopy, and biopsy. Treatment performed was nephroureterectomy of the graft with bladder cuff and regional lymphadenectomy. Pathological examination showed in both cases a locally advanced and high grade urothelial carcinoma of the pelvis allograft. After 24 and 14 months of followup, both patients are disease free. Conclusions. TCC of the kidney graft is an infrequent tumor that has only been reported in a few cases in the literature. It usually appears at a lower age, more often locally advanced, and with poor differentiation. A multidisciplinary approach to treatment should be required in these cases. 1. Introduction Nowadays, it is widely known that renal transplantation (RT) is the optimal treatment for end stage renal disease. However, after solid organ transplantation, there is a significant increased risk of developing a malignant neoplasm that varies based on cancer type [1]. This condition after RT is believed to depend on the length and type of immunosuppression or is associated with some viral infections. This risk is especially high for nonmelanoma skin cancer, hematological neoplasms, renal cell carcinoma, and thyroid cancer. Instead of this, prostate, testicular, or breast cancers have a lower risk [2]. Other tumors associated to viral infections and induced by that condition—such as hepatobiliary, cervical, or vulvovaginal neoplasms—have a higher incidence on transplant recipients. Transitional cell carcinoma (TCC) of the urinary tract is one of those tumors that appear also more commonly on transplanted population than nontransplanted, varying its incidence according to the series from 0,07% [3] to 1,9% [4]. The possible cause for the increased risk of cancer in this population is due to immunosuppression, which
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