The safety and efficacy of Bacillus Calmette‐Guerin intravesical therapy in kidney transplant recipients with superficial bladder cancer

Abstract

Kidney transplantation increases the life expectancy of recipients; however, it also increases three-fold the risk of urothelial cancer. 1 In fact, de novo bladder cancer (BC) can be diagnosed many years after kidney transplantation, with smoking being the most important risk factor. [1][2][3][4][5] Most BCs in kidney transplant recipients are non-muscle-invasive (NMIBC) and are characterized with an aggressive course. 1 Bacillus Calmette-Guerin (BCG) is an attenuated form of Mycobacterium bovis that can be used as adjuvant treatment for high-risk NMIBC. 1,5 However, two important issues emerge in this setting: would this treatment be equally effective in these immunosuppressed patients and would infectious complications be more frequent and/or severe?Administration of immunosuppressive drugs is necessary after kidney transplantation to improve both recipient and allograft survival. However, these drugs may also alter the host's immune response to BCG and with that reduce the oncologic efficacy of BCG therapy. For this reason, BCG therapy was never used in this immunocompromised population until recently. Initial reports suggested the efficacy and safety of BCG therapy in kidney transplant recipients. 6,7 Later on, different BCG regimens were administered to recipients with NMIBC and resulted in favorable oncologic outcomes, 3,5,8 although other recipients needed consolidation BCG therapy and even surgery. 2,4 Table 1 summarizes the most relevant studies that addressed the efficacy of BCG therapy in kidney transplant recipients. These studies consist mainly of case reports

Clinical characteristics and treatment outcomes of kidney transplant recipients with de novo urothelial carcinoma: thirty years of experience from a single center

“…However, its use in the renal transplant population remains controversial due to concerns about the safety of using BCG in an immunosuppressed state [ 17 ]. Although some studies have shown that bladder infusion chemotherapy with BCG is both safe and effective [ 18 , 19 ], there have been cases of systemic infection following bladder infusion with BCG [ 20 ]. In this study, we used non-live vaccine-like drugs, such as epirubicin and mitomycin, for bladder instillation.…”