Oncologic Outcomes of Post-Kidney Transplantation Superficial Urothelial Carcinoma

To analyze the oncologic effect of post-kidney transplantation (KT) immunosuppressive status for end-stage renal disease (ESRD) patients with superficial urothelial carcinoma.

From 2010 to 2015, there were 106 ESRD patients with superficial urinary bladder urothelial carcinoma (UB-UC) and 68 ESRD patients with superficial upper urinary tract urothelial carcinoma (UT-UC) in a single institution. Oncologic outcomes including bladder cancer recurrences and systemic disease recurrences within 5 years were compared between patients with and without KT. Superficial urothelial carcinoma was defined as Tis/Ta/T1 without nodal disease or distant metastasis. All the patients underwent standard transurethral resection of bladder tumor (TURBT) for superficial UB-UC and radical nephroureterectomy for superficial UT-UC.

Patients with KT were younger according to our observation. Female predominance was noted in patients with UT-UC and post-KT UB-UC. Pathological stages were distributed similarly in UB-UC and UT-UC groups whether they underwent KT or not. More bladder cancer recurrences within 5 years were found in ESRD patients with KT after TURBT for superficial UB-UC compared with those without KT (77.7% vs 38%, P = .032). However, systemic disease recurrences were similar in the 2 groups (11% vs 1%, P = .163). For superficial UT-UC, there were no differences in bladder cancer recurrences and systemic disease recurrences in the 2 groups (25% vs 39%, P = .513 and 16% vs 3.5%, P = .141).

For post-KT superficial urothelial carcinoma, radical surgery seems to result in better oncologic outcome. However, radical cystectomy is not a standard treatment choice for superficial bladder cancer. A higher incidence of bladder cancer recurrence after TURBT was found in ESRD patients with KT than those without KT.