Management of bladder cancer after renal transplantation Journal Article

Authors: Prabharasuth, D.; Moses, K. A.; Bernstein, M.; Dalbagni, G.; Herr, H. W.
Article Title: Management of bladder cancer after renal transplantation
Abstract: 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-Guérin (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. © 2013 Elsevier Inc.
Journal Title: Urology
Volume: 81
Issue: 4
ISSN: 0090-4295
Publisher: Elsevier Science, Inc.  
Date Published: 2013-04-01
Start Page: 813
End Page: 819
Language: English
PROVIDER: scopus
PUBMED: 23290344
DOI: 10.1016/j.urology.2012.11.035
Notes: --- - "Export Date: 1 May 2013" - "CODEN: URGYA" - ":doi 10.1016/j.urology.2012.11.035" - "Source: Scopus"
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MSK Authors
  1. Guido Dalbagni
    250 Dalbagni
  2. Kelvin A Moses
    6 Moses
  3. Harry W Herr
    401 Herr