Patients With Renal Transplant or End-Stage Renal Disease Present With More Advanced Bladder Cancer

Should intravesical Bacillus Calmette-Guérin be employed in transplant recipients with bladder carcinoma?

“…Although the use of immunosuppressive agents effectively prevents allograft rejection, it also predisposes transplant patients to an increased risk of malignancy (2, 3). Compared with the general population, transplant recipients with de novo malignancy post transplant are likely to be diagnosed at an advanced stage and have lower disease‐specific survival at most stages for each tumor type (4, 5). Furthermore, malignancy has emerged as one of the major causes of death in the renal transplant population, and contributes to cancer‐related deaths in younger transplant recipients (6–8).…”

“…Bladder cancer accounted for 18.8% of all reported malignancies in the Israel Penn International Transplant Tumor Registry from 1980 to 2007, with a reported incidence of 0.08–0.37% in renal transplant recipients (4, 9, 11, 12). Although a majority (49–63%) of the renal transplant recipients with bladder cancer are diagnosed with non‐muscle‐invasive disease (stage less than T2) compared with the general population, they are more likely to present with muscle invasive disease (stage T2 or greater) (37–51% vs. 22–24%) (4, 5). The initial treatment for non‐muscle‐invasive disease comprises a complete cystoscopic (transurethral) resection of all visible bladder tumor (TURBT) followed by adjuvant intravesical therapy to reduce the recurrence rate.…”