The outcome of post‐transplant transitional cell carcinoma in 10 renal transplant recipients

Abstract

At our clinic we followed 320 renal transplant recipients, 16 of whom developed malignancies within 15 yr. Ten of the 16 malignancies were transitional cell carcinoma (TCC) of the urinary tract. The modalities of treatment included standard nephroureterectomy with bladder cuff removal for upper tract tumor, transurethral resection for superficial bladder tumor and partial cystectomy for one case of invasive bladder tumor, as requested by the patient. Post-operative intravesical chemotherapy with epirubicin, or immunotherapy with bacillus Calmette-Guerin (BCG) were carried out for superficial bladder tumor. Cyclosporine (CsA) used as post-transplant immunosuppressant was switched to low dose azathioprine (Aza) at the initial diagnosis of TCC. Four patients experienced tumor recurrence despite conversion of immunosuppressant from CsA to Aza. Among these 10 patients, five maintained normal renal function, three returned to hemodialysis without tumor recurrence, and two patients died of cancer.

Glucocorticoid therapy and risk of bladder cancer

“…Oral glucocorticoid users appeared to be at an enhanced risk of specifically developing invasive, TP53 positive (3 þ staining intensity) bladder cancer compared with non-users. This is supported by previous research that has observed more rapid progression of transitional cell carcinomas in immunosuppressed patients (Wang et al, 2002). This is perhaps because tumours are able to progress more quickly with diminished immunosurveillance.…”

Management of Bladder Cancer following Solid Organ Transplantation

“…It should be noted that while there were no adverse reactions to BCG, all 3 patients were treated with prophylactic isoniazid and rifampin [27]. The safe administration of intravesical BCG without concomitant antituberculin prophylaxis has also been reported in 3 immunosuppressed renal transplant recipients [3, 28]. In the present study, we demonstrate the safe and efficacious administration of adjuvant intravesical BCG therapy in 4 immunosuppressed transplant recipients.…”

High incidence and recurrence of transitional cell carcinoma in Taiwanese patients with end‐stage renal disease

“…However, these features are common in all dialysis patients, so they cannot explain the unusually high prevalence in Taiwan. In addition, after uraemia and oliguria are corrected by renal transplantation, the incidence of TCC is even higher in Taiwan 11 . In a retrospective study, Chang et al 10 .…”

“…There is strong evidence of increased cancer risk in patients with chronic kidney disease, 1 in patients with end‐stage renal disease (ESRD) being treated with chronic dialysis 2–10 and in renal transplant recipients 11,12 . Taiwan continues to have the highest incidence and prevalence of ESRD in the world.…”