title: Intravesical bacillus Calmette-Guérin instillation therapy for non-muscle-invasive bladder cancer following solid organ transplantation.
abstract: BACKGROUND
  Solid organ recipients have a substantial risk of developing bladder cancer, with high-risk non-muscle-invasive bladder cancer (NMIBC) being the most frequent diagnosis. Theoretically, adjuvant bacillus Calmette-Guérin (BCG) therapy is contraindicated, but limited data indicate its feasibility. The objective of this study was to evaluate the safety and efficacy of BCG following solid organ transplantation.
  
  
  METHODS
  We reviewed the data of four solid organ recipients who received adjuvant BCG for high-risk NMIBC at our institution. Additionally, individual data of 12 patients were extracted from case series and case reports, which were identified through a systematic review of the literature. A meta-analysis was performed.
  
  
  RESULTS
  Fourteen patients (88 %) had received a kidney, one a heart, and one a liver transplant. The median time from transplantation to bladder cancer was 60.5 months. The regimen of immunosuppression was not modified in 12 patients (75 %). Forty-two percent of patients did not receive prophylactic antibiotics, and 70 % had no side effects. Ten patients (63 %) experienced recurrence after a median of 14 months. Progression to muscle-invasive or metastatic disease was observed in two patients (13 %). Four patients (25 %) underwent radical cystectomy, and two patients died of the disease.
  
  
  CONCLUSIONS
  BCG therapy is a safe option for patients with high-risk NMIBC following solid organ transplantation. However, there is a substantial risk of recurrence and progression. Urologists and patients considering BCG therapy should be aware of this and may consider early cystectomy. There is no evidence to support the need for prophylactic antibiotics.
authors.affiliation: Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
authors.forename: Natalia
authors.initials: N
authors.lastname: Swietek
authors.forename: Matthias
authors.initials: M
authors.lastname: Waldert
authors.forename: Martin
authors.initials: M
authors.lastname: Susani
authors.forename: Georg
authors.initials: G
authors.lastname: Schatzl
authors.forename: Tobias
authors.initials: T
authors.lastname: Klatte
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000009:adverse effects; D000283:Administration, Intravesical; D001500:BCG Vaccine / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000209:etiology / Q000473:pathology; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods; D009361:Neoplasm Invasiveness; D016377:Organ Transplantation / Q000009:adverse effects*; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine
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