Urothelial cancers after renal transplantation

After solid organ transplantation, risk of cancer varies significantly based on cancer type. In this study, we determine the incidence of urothelial cancers (bladder and kidney) after renal transplantation from a single high-volume transplantation institution. In addition, we analyze the risk factors and review outcomes from the patients.

We performed a retrospective review of all patients in the University of Alabama at Birmingham (UAB) transplant database to identify all patients who received renal transplants at UAB between January 1, 1990, and January 1, 2010. We further identified transplant patients diagnosed with bladder, urothelial of other cancers in the same time period. We also examined tumor-specific variables such as presentation, clinical and pathologic staging, treatment type, recurrence, progression, interval to recurrence and progression, cancer-specific mortality, and interval from time to diagnosis to death.

Review of the transplant database confirmed 5,920 renal transplants. Thirteen patients underwent the diagnosis of urothelial cancer, providing an incidence of 0.2%. Eight patients had bladder cancer for an incidence of 0.13%, compared to an incidence of 0.02% among the general population. Patients diagnosed with bladder cancer after renal transplantation were younger than those in the general population and frequently present with more advanced and aggressive disease.

Patients are at an elevated risk of urothelial cancers after renal transplantation probably from immune suppression.