Longitudinal Trends of Urologic Malignancy After Solid Organ Transplantation at a High-Volume Transplant Center

Introduction Since the advent of solid organ transplantation, there have been many concerns related to the risks of immunosuppression and malignancy. The impact of transplantation on cancer risk warrants continued evaluation of contemporary malignancy patterns. We assessed current trends at our high-volume transplant center. Methods A single-center retrospective analysis was performed at a high-volume transplant center in South Carolina for adult patients with a history of solid organ transplant who subsequently had a new urologic malignancy between 2008 and 2023. The malignancies were delineated with International Classification of Diseases, 10th Revision (ICD-10) codes for the bladder, urethra, ureter, renal pelvis, kidney, prostate, adrenal, penis, and testis. Demographic, transplant, and malignancy data were analyzed. Outcomes were analyzed for mortality rate, and univariate survival analysis was performed. Results Eighty-one patients met the inclusion criteria. The mean age at transplant was 56 years, and the mean age at cancer diagnosis was 60 years. The breakdown of cancers from most to least common was prostate (41%, 33), kidney (38%, 31), bladder (19%, 15), upper tract urothelial (1%, 1), and urethra (1%, 1). The mortality rate was 0.06 for urothelial, 0.05 for kidney, and 0.02 for prostate, compared with national averages of 0.005, 0.005, and 0.011, respectively. Survival analysis demonstrated significantly decreased survival for patients with urothelial malignancy after transplant compared with prostate cancer (p<0.01). Conclusions We found a significantly increased proportion of kidney and bladder malignancy in transplant patients in comparison to the South Carolina and national yearly incidence of these cancers in our single-institution high-volume transplant center.