title: Management of bladder cancer after renal transplantation.
abstract: OBJECTIVE
  To review our experience managing bladder cancer (BCa) in patients who have had renal transplantation. Optimal oncologic treatment can be challenging due to the immunosuppressed state and higher comorbidity.
  
  
  METHODS
  From January 2000 to August 2011, we identified 17 patients with a history of renal transplantation who were treated for BCa. Clinical, demographic, and oncologic data were collected. Patients treated with intravesical bacillus Calmette-Guérin (BCG) were assessed for complications.
  
  
  RESULTS
  BCa diagnosis occurred at a median of 88.1 months after renal transplantation. Median age was 62.4 years and median follow-up was 9.2 months. The most common presentation was gross hematuria (58.8%), and the median Charlson comorbidity index was 5. Twelve patients were identified with non-muscle invasive (NMI) BCa. Four patients with NMI BCa received intravesical BCG, with no urinary tract infection, fever, or BCG-associated sepsis. Four patients were identified with muscle-invasive bladder cancer (MIBC), and 1 patient had biopsy proven metastatic disease. Five patients underwent radical cystectomy (RC) with diversion, 7 underwent transurethral resection and surveillance, 3 underwent chemotherapy, and 1 received palliative radiation for metastatic disease. Overall, 6 patients were deceased, 4 of whom died of disease at a median of 9.7 months from the time of BCa diagnosis.
  
  
  CONCLUSIONS
  Treatment of patients with BCa after renal transplantation is challenging because of immunosuppression and overall high comorbidity. Optimal management with stage-appropriate therapy should be considered in appropriate patients. Intravesical BCG may be considered in select patients, although overall efficacy may be reduced.
authors.affiliation: Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Prabharasuth
authors.forename: Kelvin A
authors.initials: KA
authors.lastname: Moses
authors.forename: Melanie
authors.initials: M
authors.lastname: Bernstein
authors.forename: Guido
authors.initials: G
authors.lastname: Dalbagni
authors.forename: Harry W
authors.initials: HW
authors.lastname: Herr
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000283:Administration, Intravesical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001500:BCG Vaccine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000628:therapy*
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine