This is an outstanding article comparing renal cancers found in patients with end-stage renal disease, differentiating for the first time, to my knowledge, that tumour pathology, age at diagnosis, progression-free survival (PFS) and disease-specific survival (DSS) differ when the cancers are found in transplanted vs dialysis-only patients. The article is additionally informative in its supposition that earlier detection of cancers (with associated smaller tumours of lower stage and less evidence of metastasis at diagnosis) in the transplanted patients may have been due to the fact that, in France, transplanted patients are followed by urologists who might be more likely to monitor the native kidneys, whereas dialysis-only patients are followed by nephrologists who may not share the same monitoring strategy. Such earlier diagnosis in the transplanted patients could easily influence size and stage as well as metastases of cancers at diagnosis and unquestionably exerted some effect on PFS and DSS, but the surprising finding of this article was that the cancers were histologically dissimilar, with a significant percentage (44%) of the lesser aggressive papillary cancer in transplanted patients compared with a predominance of clear cell cancer (77%) in the dialysis-only counterparts. The authors admit that a limitation of their study is that they were unable to perform a centralised review of all pathology in this report derived from 24 separate centres in France. They should be encouraged to pursue this venture in a subsequent report as the pathological distinction between transplanted and dialysis-only populations demands investigation.