Urologic challenges in renal transplantation: Malignancies, complications, and strategies to expand the donor pool

Advances in renal transplantation have improved patient survival, but aging donor and recipient populations have increased the complexity of transplant care. Urologic malignancies and complications are increasingly important in this population: the reported risk of renal cell carcinoma is 2- to 10-fold higher and bladder cancer incidence is approximately 2- to 4-fold higher than in the general population. Urinary tract complications occur in 1% to 30% of recipients, highlighting the expanding role of urologists in transplant care. This comprehensive literature review summarizes the current role of urology in renal transplantation, focusing on the epidemiology and management of urologic malignancies relative to the general population, common posttransplant urologic complications and their management, and urologic strategies for expanding the donor pool. As the number and complexity of kidney transplant recipients continue to increase, transplant surgeons and general urologists need to understand these unique challenges. A multidisciplinary and individualized approach is essential to optimize outcomes, preserve graft function, and safely expand access to transplantation.