Background and Objectives: Renal transplant recipients (RTRs) have a 2- to 7-fold risk of developing a neoplasm compared to general population. Bladder urothelial neoplasms in this cohort has an incidence of 0.4–2%. Many reports describe a more aggressive behavior. The objective of this study is to describe oncologic characteristics of bladder urothelial neoplasms in RTRs and to evaluate its recurrence, progression, and survival rates. Methods: A retrospective multicentered study was performed evaluating all de novo bladder urothelial neoplasms cases in RTRs from 1988 to 2014. Descriptive statistical analysis and evaluation of recurrence, progression, and survival rates were performed. Results: A total of 28 de novo bladder transitional cell carcinomas (TCCs) were identified (incidence rate 0.64%). Cancer-specific survival rates were 100, 75, and 70% after 1, 5, and 10 years, respectively. Age at diagnosis superior to 60 years was found to be a statistically significant variable for recurrence risk. Progression rate was 14%. Presence of CIS was significantly associated with progression. All cancer-specific deaths were in the high-risk group and all were progressions from non-muscle invasive to muscle invasive bladder cancer. Conclusions: Bladder urothelial neoplasms following renal transplant is associated with a trend toward worst prognosis. Early aggressive treatments, such as early radical cystectomy, might be advisable to reduce cancer-specific deaths.

1.
Andrés A: Cancer incidence after immunosuppressive treatment following kidney transplantation. Crit Rev Oncol Hematol 2005; 56: 71–85.
2.
Mahoney JF, Caterson RJ, Coulshed S, Stewart JH, Sheil AG: Twenty and 25 years survival after cadaveric renal transplantation. Transplant Proc 1995; 27: 2154–2155.
3.
Penn P: Post-transplant malignancies. Transplant Proc 1999; 31: 1260–1262.
4.
Rogers A, Ng JK, Glendinning J, Rix D: The management of transitional cell calrcinoma (TCC) in a European regional renal transplant population. BJU Int 2012; 110:E34–E40.
5.
Babjuk M, Burger M, Zigeuner R, Shariat SF, van Rhijn BW, Compérat E, Sylvester RJ, Kaasinen E, Böhle A, Palou Redorta J, Rouprêt M: European Association of Urology. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. Eur Urol 2013; 64: 639–653.
6.
Phyllips B, Ball C, Sackett D: Levels of Evidence and Grades of Recommendation. Oxford Centre for Evidence Based Medicine web site. http://www.cebm.net/index.aspx?o=1025.
7.
European Urology Guidelines: Renal Transplantation. Last Update, 2009, pp 6–75.
8.
Budde K, Glander P: Pharmacokinetic principles of immunosuppressive drugs. Ann Transplant 2008; 13: 5–10.
9.
Kyllonen L, Samela K, Pukkala E: Cancer incidence in a kidney-transplant population. Transplant Int 2000; 13(suppl 1):S394–S398.
10.
Yan L, Chen P, Chen EZ, Gu A, Jiang ZY: Risk of bladder cancer in renal transplant recipients: a met-analysis. Br J Cancer 2014; 110: 1871–1877.
11.
Ferlay J, Bray F, Forman D, et al: GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 10 2010, International Agency for Research on Cancer. Lyon, France.
12.
Chiang YJ, Yang PS, Wang HH, Lin KJ, Liu KL, Chu SH et al: Urothelial cancer after renal transplantation: an update. Transplant Proc 2012; 44: 744–745.
13.
Wu MJ, Da Lian J, Yang CR, Cheng CH, Chen CH, Lee WC, et al: High cumulative incidence of urinary tract transitional cell carcinoma after kidney transplantation in Taiwan. Am J Kidney Dis 2004; 43: 1091–1097.
14.
Keck B, Ott OJ, Häberle L, Kunath F, Weiss C, Rödel C, Sauer R, et al: Female sex is an independent risk factor for reduced overall survival in bladder cancer patients treated by transurethral resection and radio- or radiochemotherapy. World J Urol 2013; 31: 1023–1028.
15.
Ather MH, Zaidi M: Predicting recurrence and progression in non-muscle invasive bladder cancer using European organization of research and treatment of cancer risk tables. Urol J 2009; 6: 189–193.
16.
Master V, Meng M, Grossfeld G, Koppie TM, Hirose R, Carroll P: Treatment and out come of invasive bladder cancer in patients after renal transplantation. J Urol 2004; 171: 1085–1088.
17.
Prabharasuth D, Moses KA, Bernstein M, Dalbagni G, Herr H: Management of bladder cancer after renal transplantation. Urology 2013; 81: 813–819.
18.
Bohle A, Bock PR: Intravesical Bacillus Calmette-Guerin versus mitomycin C in superficial bladder cancer: formal meta-analysis of comparative studies on tumour progression. Urology 2004; 63: 682–686.
19.
Wang SM, Tai HC, Chueh SC, Chung SD, Lai MK: Sirolimus does not absolutely bolish the occurrence/recurrence of urothelial carcinoma in renal transplant recipients. Transplant Proc 2008; 40: 2395–2396.
20.
Kahan BD, Knight R, Schoenberg L: Ten years of Sirolimus therapy for human renal transplantation: the university of Texas at Huston experience. Transplant Proc 2003; 35: 25S–34S.
21.
Van den Bosh S, Alfred Witjes J: Long-term cancer-specific survival in patients with high-risk, non-muscle invasive bladder cancer and tumour progression: a systematic review. Eur Urol 2011;60: 493–500.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.