Risk of bladder cancer in renal transplant recipients: a meta-analysis

Abstract

Background:Renal transplantation has been associated with a significantly increased risk of developing cancers during long-term follow-up, but for bladder cancer, this risk is less clear. We therefore performed a meta-analysis to determine whether bladder cancer risk in renal transplant recipients was increased.Methods:Eligible studies were identified through searches of PubMed and other public resources. Random-effects meta-analyses were used to pool overall estimates for standardised incidence ratios (SIRs). Heterogeneity test, sensitivity analysis, and assessment of publishing bias were also performed.Results:We identified a 3.18-fold higher SIR (95% confidence intervals (CI): 1.34–7.53, P=0.008) of bladder cancer in patients following renal transplantation compared with the general population, based on data from 79 988 patients with a total follow-up of 308 458 patient-years. When stratified by ethnicity, the SIRs for bladder cancer were 2.00 (95% CI: 1.51–2.65, P=0.001) and 14.74 (95% CI: 3.66–59.35, P<0.001) between European and Asian renal transplant recipients, respectively.Conclusions:Our study demonstrated that the risk of developing bladder cancer in transplant populations was increased. Such association suggests that physicians should be more vigilant in checking for bladder cancer in transplantation recipient population.

De Novo Bladder Urothelial Neoplasm in Renal Transplant Recipients: A Retrospective, Multicentered Study

“…BC incidence in the present study is 0.9%, which is in line with literature findings that ranges between 0.3 and 2% [4]. A recent meta-analysis of most actual and well-conducted available studies has been performed by Yan et al [10] to determine whether the overall standard incidence ratio (SIR) of BC is increased in RTRs compared to standard population. Their results showed a significantly increased risk of developing BC in transplant populations compared with the general population (SIR 3.18, 95% CI 1.34-7.53, p = 0.008).…”

“…Their results showed a significantly increased risk of developing BC in transplant populations compared with the general population (SIR 3.18, 95% CI 1.34-7.53, p = 0.008). When stratified by ethnicity, the SIR for BC was 2.00 (95% CI 1.51-2.65, p = 0.001) among Europeans and much higher (14.74) among Asian RTRs (95% CI 3.66-59.35, p < 0.001) suggesting the presence of ethnicity-based differences [10]. The marked difference in incidence of TCC in RTRs in the far east compared with Western countries could be due, in part, to the use of Chinese herbs such as rhubarb and aristolochic acid, which have been associated with an increased cancer risk [4].…”

Post‐transplant malignancy in solid organ transplant recipients in Ireland, The Irish Transplant Cancer Group

“…Our estimates for bladder cancer agree with other international estimates . Much of the reported literature to date on urological cancers post‐transplant pertains specifically to kidney transplant recipients; however, we have also noted a somewhat elevated incidence of bladder cancer in heart and liver recipients.…”

“…Of the viral factors, BK virus is particularly increasingly implicated . In our cohort of kidney transplant recipients with glomerulonephritis as primary cause of end‐stage kidney disease (ESKD), a surrogate for immunosuppression and possible cyclophosphamide exposure prior to transplant was associated with eventual bladder cancer development . Pretransplant prostate screening may account for the low incidence post‐transplant.…”

Urologic malignancies in kidney transplantation

“…The overall SIR for bladder cancer among renal transplant patients compared with the general population ranges from 1.6 to 3.3, with the highest SIR among Asian renal transplant recipients (SIR 14.74) . Risk factors for the development of bladder cancer from a multivariate analysis in the post–renal transplantation population included polyomavirus infection (ie, BK virus [BKV]) (RR 11.6) and smoking (RR 6.1) .…”