Comparison of Clinical Outcomes of Upper Tract Urothelial Carcinoma between Patients after Renal Transplantation and on Dialysis: A Long-Term Single-Center Cohort Study.

Abstract

This study aimed to compare clinical outcomes between patients who received renal transplantation (RT) and those maintained on dialysis. We retrospectively analyzed 133 patients (34 RT, 99 dialysis) with unilateral UTUC treated with unilateral radical nephroureterectomy (RNU). Propensity score matching (PSM) with a 0.02 caliper balanced baseline characteristics, yielding 34 matched pairs. Overall survival was assessed by Kaplan-Meier; cancer-specific survival, bladder recurrence-free survival, and contralateral recurrence-free survival were analyzed via cumulative incidence functions and Gray's test in a competing-risk framework. Multivariate Fine-Gray regression identified independent predictors. Sensitivity analyses used the unmatched cohort, and all models were validated by a biostatistician. Compared with dialysis patients, the RT group was significantly younger and had a higher proportion of larger tumors. Before PSM, Kaplan-Meier analysis revealed significant differences in contralateral recurrence-free survival (CRFS) and cancer-specific survival (CSS) between the two groups, but no significant differences in overall survival (OS) or bladder recurrence-free survival (BRFS). Multivariate Fine-Gray regression identified RT as an independent risk factor for worse CRFS, but not for CSS. After PSM, a significant difference in CRFS persisted between the groups, while no significant differences were observed in OS, CSS, or BRFS. RT yields overall survival comparable to dialysis but confers a substantially increased risk of contralateral recurrence. Prophylactic contralateral nephroureterectomy should be reserved for highly selected high-risk patients after multidisciplinary evaluation.