Bladder carcinoma among live‐donor renal transplant recipients: a single‐centre experience and a review of the literature

Abstract

OBJECTIVES To present our experience with bladder cancer among a renal transplant population and to review critically the relevant literature. PATIENTS AND METHODS In all, 1865 renal graft recipients were followed for a mean (sd) of 6.5 (5) years. Seven recipients (all men) developed a urothelial bladder tumour. The stage and grade of the tumours were determined. The method of the treatment was selected on the basis of the tumour characteristics and graft function. Patients were regularly followed; the endpoints were cancer‐specific survival, recurrence or metastasis. RESULTS All patients presented with gross haematuria. There was non‐muscle‐invasive disease in two patients who were treated by transurethral resection and adjuvant intravesical bacille Calmette‐Guérin immunotherapy. One patient died 24 months later due to complications of end‐stage renal disease. To date the second patient is alive and free of the recurrence. Five recipients with muscle‐invasive disease had a radical cystectomy and orthotopic bladder substitution. The mean (sd) time to the last follow‐up or death was 14.6 (3.1) months. Three patients died with stable graft function; two from distant metastasis and one from a cerebrovascular stroke. The remaining two patients are still alive, free of disease and with good graft function. CONCLUSIONS Urothelial bladder tumours are generally uncommon. The presence of haematuria in renal allograft recipients should be thoroughly investigated. Early diagnosis and prompt treatment are required for managing such tumours, because they are aggressive. Orthotopic bladder substitution is feasible with a good functional outcome for patients in whom cystectomy is indicated.

Urothelial cancers after renal transplantation

“…As found in this study and in others [12], an overwhelming majority of patients with urothelial cancer presented with gross hematuria. However, despite strict follow-up guidelines, many of the patients in the aforementioned studies still presented with advanced and aggressive disease, suggesting immunosuppression in solid organ recipients is associated with rapid progression of cancers [1].…”

“…The incidence in a recent French study was 0.4% [11]. An Egyptian report found 7 bladder cancers of 1,865 patients, following renal transplantation for an incidence of 0.4%, with a strong correlation with previous bilharzial infection [12]. As far as presentation at cancer diagnosis, most patients in our study were found to have advanced disease and many were metastatic at presentation.…”

Neoplasias urológicas de novo en pacientes trasplantados renales: experiencia en 1.751 pacientes

“…El tratamiento de los tumores vesicales no músculo-invasivos en la población trasplantada aún no está consensuado, aceptándose la resección transuretral más quimioterapia endovesical como la terapia de elección 42 . Sin embargo, algunos autores como Kamal et al 43 sugieren que el uso en estos pacientes de la terapia con bacilo de CalmetteGuérin como inmunoterapia coadyuvante estaría indicada en algunos tumores, ya que disminuiría las recurrencias y mejoraría la supervivencia libre de enfermedad. Sin embargo, puede plantear problemas y podría conducir a una infección tuberculosa severa.…”

“…A los tumores vesicales músculo-invasivos se les realizó una cistectomía radical con derivación tipo Bricker, y en todos ellos se pudo conservar el trasplante. Algunos autores como Kamal et al 43 y Lang et al 44 sugieren que se puede realizar una reconstrucción con una vejiga ortotópica; estos autores no encontraron diferencias en cuanto a morbilidad ni mortalidad cuando realizaron esta técnica; si bien, el procedimiento tiene una mayor dificultad y sólo se debería plantear en los pacientes con un injerto renal en perfecto funcionamiento. Además, observaron que la afectación del riñón y el uréter del donante no suelen presentar recidivas o tumores uroteliales.…”

Glucocorticoid therapy and risk of bladder cancer

“…Bladder cancer is a far less common disease than skin cancer, and thus it is not surprising that cohort studies would observe few if any cases (Master et al, 2004;Kamal et al, 2007). An exception was a Taiwanese study that reported bladder cancer as the most common type of post-transplant malignancy with an incidence of 4.1% among kidney transplant recipients (Wu et al, 2004).…”