Management of Bladder Cancer After Renal Transplantation

OBJECTIVE To review our experience managing bladder cancer (BCa) in patients who have had renal transplantation. Optimal oncologic treatment can be challenging due to the immunosuppressed state and higher comorbidity. METHODS From January 2000 to August 2011, we identified 17 patients with a history of renal transplantation who were treated for BCa. Clinical, demographic, and oncologic data were collected. Patients treated with intravesical bacillus Calmette-Guerin (BCG) were assessed for complications. RESULTS BCa diagnosis occurred at a median of 88.1 months after renal transplantation. Median age was 62.4 years and median follow-up was 9.2 months. The most common presentation was gross hematuria (58.8%), and the median Charlson comorbidity index was 5. Twelve patients were identified with non-muscle invasive (NMI) BCa. Four patients with NMI BCa received intravesical BCG, with no urinary tract infection, fever, or BCG-associated sepsis. Four patients were identified with muscle-invasive bladder cancer (MIBC), and 1 patient had biopsy proven metastatic disease. Five patients underwent radical cystectomy (RC) with diversion, 7 underwent transurethral resection and surveillance, 3 underwent chemotherapy, and 1 received palliative radiation for metastatic disease. Overall, 6 patients were deceased, 4 of whom died of disease at a median of 9.7 months from the time of BCa diagnosis. CONCLUSION Treatment of patients with BCa after renal transplantation is challenging because of immunosuppression and overall high comorbidity. Optimal management with stage-appropriate therapy should be considered in appropriate patients. Intravesical BCG may be considered in select patients, although overall efficacy may be reduced. UROLOGY 81: 813-819, 2013. (C) 2013 Elsevier Inc.