title: Histopathology and prognosis of de novo bladder tumors following solid organ transplantation.
abstract: BACKGROUND
  Patients following solid organ transplantation have an increased risk of developing de novo bladder tumors, but their biology is poorly characterized.
  
  
  METHODS
  We studied 1743 patients who underwent a transurethral resection of a newly diagnosed bladder tumor at a single institution. The histopathology, treatment, recurrence-free survival and overall survival were evaluated and compared between transplant and non-transplant patients.
  
  
  RESULTS
  We identified 74 transplant patients who developed a de novo bladder tumor after a median post-transplantation interval of 62 months. The tumor was malignant in 29 patients (39 %). The most common benign lesion was nephrogenic adenoma (84 %), which neither coexisted with nor developed into malignant tumors during follow-up. Compared with non-transplant patients (n = 1669), transplant patients were significantly younger (median 55 vs 69 years, P < 0.001) and had a 9.0-fold higher odds of benign tumors (P < 0.001), while there were no differences in pathology among patients with urothelial carcinoma of the bladder (UCB). In a multivariable analysis for non-muscle-invasive UCB that was adjusted for the risk group, patients with a transplant had a 1.8-fold increased risk of recurrence (P = 0.048). Four of five transplant patients did not respond to Bacillus Calmette-Guérin instillations. There were no differences in overall survival after radical cystectomy (P = 0.87).
  
  
  CONCLUSIONS
  The majority of bladder tumors in transplant patients are benign, and they neither coexist with nor develop into malignant tumors. Transplant patients with non-muscle-invasive UCB show an increased risk of disease recurrence, while those treated with radical cystectomy have similar outcomes to patients without a transplant.
authors: Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors: Ines A
authors: IA
authors: Ederer
authors: Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.|Department of Urology, Centre hospitalier universitaire vaudois, Lausanne, Switzerland.
authors: Ilaria
authors: I
authors: Lucca
authors: Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors: Sebastian L
authors: SL
authors: Hofbauer
authors: Clinical Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors: Michael
authors: M
authors: Haidinger
authors: Clinical Institute of Pathology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors: Andrea
authors: A
authors: Haitel
authors: Clinical Institute of Pathology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors: Martin
authors: M
authors: Susani
authors: Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria.|Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.|Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria. tobias.klatte@gmx.de.
authors: Tobias
authors: T
authors: Klatte
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D015653:Cystectomy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy
keywords: Bladder; Cystectomy; Endoscopy; Nephrogenic adenoma; Recurrence; Survival; Transplantation