Incidence and long-term outcomes of squamous cell bladder cancer after deceased donor renal transplantation

ObjectiveTo review the incidence and long-term outcomes of squamous cell carcinoma (SCC) of the bladder in patients after kidney transplantation. MethodsBetween January 1976 and March 2013, five patients from one center (0.0013%) developed SCC of the bladder after undergoing a deceased donor kidney transplant. Their relevant risk factors included long-term self-intermittent catheterization/indwelling catheter (n=2), smoking history (n=2), and a prior history of cyclophosphamide treatment for vasculitis (n=1). Primary outcome variables were overall patient survival and latency period between transplantation and SCC diagnosis. ResultsThe duration of long-term follow-up was 9489 (range: 4-239) months. The latency period between transplantation and bladder SCC was 87 +/- 87 (range: 2-228) months, and all five patients were immunosuppressed with tacrolimus, mycophenolate mofetil, and prednisone. Four patients had suspected metastases upon presentation, and one patient presented with organ-confined disease. This patient underwent a radical cystectomy and remains disease free eightmonths post-operatively. Despite radical treatment, the remaining four patients died from metastatic disease 7 +/- 4.4 (range: 2-11) months after their initial diagnosis. ConclusionSCC of the bladder has a poor prognosis particularly in renal transplant patients. Early detection with flexible cystourethroscopy in patients with risk factors for SCC may improve long-term outcomes in this patient cohort.