Radical cystectomy for bladder cancer in solid organ transplant recipients

Solid organ transplant recipients (SOTRs) face higher cancer risk because of immunosuppressive therapy used to prevent organ rejection. We hypothesized that SOTRs treated with radical cystectomy (RC) and pelvic lymph-node dissection (PLND) for bladder cancer (UBC) might have worse survival outcomes compared to non-SOTRs. This study aims to assess survival outcomes of SOTRs treated with RC and PLND for UBC compared to non-SOTRs.

A retrospective analysis of 645 patients treated with RC and PLND for UBC, originating from our multicenter cooperation program (2002-2022), stratified in two groups according to previous solid organ transplantation. Co-primary endpoints were OS and CSS, assessed using mixed-effects Cox-analysis. Secondary endpoints included postoperative complications, readmission-rates, operation time, estimated blood loss and length of stay.

Of the 361 patients analyzed (median follow-up: 17 months), 23 were SOTRs. SOTRs exhibited lower 12-month (70% vs. 80%) and 24-month (36% vs. 68%) OS-rates compared to non-SOTRs (P=0.011). Corresponding CSS-rates were also lower for SOTRs at 12 (81% vs. 85%) and 24 months (55% vs. 76%) (P=0.016). Multivariable Cox-regression identified a prior solid organ transplant (OR:5.2; P=0.002), higher pathologic-stage (OR:3.8; P=0.03 for pT2, OR:3.6; P=0.04 for pT3, OR:4.5; P=0.03 for pT4), and administration of "any systemic treatment" (OR:0.3; P=0.001) as OS predictors. For CSS, predictors were a prior solid organ transplant (OR:3.0; P=0.03), higher pathologic-stage (OR:9.8; P=0.04 for pT3, OR:13; P=0.02 for pT4), and administration of "any systemic treatment" (OR:0.4; P=0.03).

Solid organ transplant recipients undergoing RC and PLND for urinary UBC have worse survival outcomes compared to non-SOTRs. Our findings may impact patient counseling, follow-up, and planning future clinical trials.