title: Incidence and long-term outcomes of squamous cell bladder cancer after deceased donor renal transplantation.
abstract: OBJECTIVE
  To review the incidence and long-term outcomes of squamous cell carcinoma (SCC) of the bladder in patients after kidney transplantation.
  
  
  METHODS
  Between January 1976 and March 2013, five patients from one center (0.0013%) developed SCC of the bladder after undergoing a deceased donor kidney transplant. Their relevant risk factors included long-term self-intermittent catheterization/indwelling catheter (n = 2), smoking history (n = 2), and a prior history of cyclophosphamide treatment for vasculitis (n = 1). Primary outcome variables were overall patient survival and latency period between transplantation and SCC diagnosis.
  
  
  RESULTS
  The duration of long-term follow-up was 94 ± 89 (range: 4-239) months. The latency period between transplantation and bladder SCC was 87 ± 87 (range: 2-228) months, and all five patients were immunosuppressed with tacrolimus, mycophenolate mofetil, and prednisone. Four patients had suspected metastases upon presentation, and one patient presented with organ-confined disease. This patient underwent a radical cystectomy and remains disease free eight months post-operatively. Despite radical treatment, the remaining four patients died from metastatic disease 7 ± 4.4 (range: 2-11) months after their initial diagnosis.
  
  
  CONCLUSIONS
  SCC of the bladder has a poor prognosis particularly in renal transplant patients. Early detection with flexible cystourethroscopy in patients with risk factors for SCC may improve long-term outcomes in this patient cohort.
authors.affiliation: Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: N F
authors.initials: NF
authors.lastname: Davis
authors.forename: L C
authors.initials: LC
authors.lastname: McLoughlin
authors.forename: C
authors.initials: C
authors.lastname: Dowling
authors.forename: R
authors.initials: R
authors.lastname: Power
authors.forename: P
authors.initials: P
authors.lastname: Mohan
authors.forename: D
authors.initials: D
authors.lastname: Hickey
authors.forename: G
authors.initials: G
authors.lastname: Smyth
authors.forename: M
authors.initials: M
authors.lastname: Eng
authors.forename: D M
authors.initials: DM
authors.lastname: Little
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D014019:Tissue Donors; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology
chemical_list: D007166:Immunosuppressive Agents
keywords: bladder cancer; immunosuppression; kidney transplant; squamous cell bladder cancer; transplantation