Ines A Ederer1, Ilaria Lucca1,2, Sebastian L Hofbauer1, Michael Haidinger3, Andrea Haitel4, Martin Susani4, Shahrokh F Shariat1,5,6, Tobias Klatte7. 1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria. 2. Department of Urology, Centre hospitalier universitaire vaudois, Lausanne, Switzerland. 3. Clinical Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. 4. Clinical Institute of Pathology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. 5. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 6. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA. 7. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria. tobias.klatte@gmx.de.
Abstract
BACKGROUND: Patients following solid organ transplantation have an increased risk of developing de novo bladder tumors, but their biology is poorly characterized. METHODS: We studied 1743 patients who underwent a transurethral resection of a newly diagnosed bladder tumor at a single institution. The histopathology, treatment, recurrence-free survival and overall survival were evaluated and compared between transplant and non-transplant patients. RESULTS: We identified 74 transplant patients who developed a de novo bladder tumor after a median post-transplantation interval of 62 months. The tumor was malignant in 29 patients (39 %). The most common benign lesion was nephrogenic adenoma (84 %), which neither coexisted with nor developed into malignant tumors during follow-up. Compared with non-transplant patients (n = 1669), transplant patients were significantly younger (median 55 vs 69 years, P < 0.001) and had a 9.0-fold higher odds of benign tumors (P < 0.001), while there were no differences in pathology among patients with urothelial carcinoma of the bladder (UCB). In a multivariable analysis for non-muscle-invasive UCB that was adjusted for the risk group, patients with a transplant had a 1.8-fold increased risk of recurrence (P = 0.048). Four of five transplant patients did not respond to Bacillus Calmette-Guérin instillations. There were no differences in overall survival after radical cystectomy (P = 0.87). CONCLUSIONS: The majority of bladder tumors in transplant patients are benign, and they neither coexist with nor develop into malignant tumors. Transplant patients with non-muscle-invasive UCB show an increased risk of disease recurrence, while those treated with radical cystectomy have similar outcomes to patients without a transplant.
BACKGROUND:Patients following solid organ transplantation have an increased risk of developing de novo bladder tumors, but their biology is poorly characterized. METHODS: We studied 1743 patients who underwent a transurethral resection of a newly diagnosed bladder tumor at a single institution. The histopathology, treatment, recurrence-free survival and overall survival were evaluated and compared between transplant and non-transplant patients. RESULTS: We identified 74 transplant patients who developed a de novo bladder tumor after a median post-transplantation interval of 62 months. The tumor was malignant in 29 patients (39 %). The most common benign lesion was nephrogenic adenoma (84 %), which neither coexisted with nor developed into malignant tumors during follow-up. Compared with non-transplant patients (n = 1669), transplant patients were significantly younger (median 55 vs 69 years, P < 0.001) and had a 9.0-fold higher odds of benign tumors (P < 0.001), while there were no differences in pathology among patients with urothelial carcinoma of the bladder (UCB). In a multivariable analysis for non-muscle-invasive UCB that was adjusted for the risk group, patients with a transplant had a 1.8-fold increased risk of recurrence (P = 0.048). Four of five transplant patients did not respond to Bacillus Calmette-Guérin instillations. There were no differences in overall survival after radical cystectomy (P = 0.87). CONCLUSIONS: The majority of bladder tumors in transplant patients are benign, and they neither coexist with nor develop into malignant tumors. Transplant patients with non-muscle-invasive UCB show an increased risk of disease recurrence, while those treated with radical cystectomy have similar outcomes to patients without a transplant.
Authors: Marko Babjuk; Maximilian Burger; Richard Zigeuner; Shahrokh F Shariat; Bas W G van Rhijn; Eva Compérat; Richard J Sylvester; Eero Kaasinen; Andreas Böhle; Joan Palou Redorta; Morgan Rouprêt Journal: Eur Urol Date: 2013-06-12 Impact factor: 20.096
Authors: C D Wimmer; M Rentsch; A Crispin; W D Illner; H Arbogast; C Graeb; K-W Jauch; M Guba Journal: Kidney Int Date: 2007-02-28 Impact factor: 10.612
Authors: Eric A Engels; Ruth M Pfeiffer; Joseph F Fraumeni; Bertram L Kasiske; Ajay K Israni; Jon J Snyder; Robert A Wolfe; Nathan P Goodrich; A Rana Bayakly; Christina A Clarke; Glenn Copeland; Jack L Finch; Mary Lou Fleissner; Marc T Goodman; Amy Kahn; Lori Koch; Charles F Lynch; Margaret M Madeleine; Karen Pawlish; Chandrika Rao; Melanie A Williams; David Castenson; Michael Curry; Ruth Parsons; Gregory Fant; Monica Lin Journal: JAMA Date: 2011-11-02 Impact factor: 157.335