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Histopathology and prognosis of de novo bladder tumors following solid organ transplantation

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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.

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Acknowledgments

IL was supported by the development fund of the CHUV University Hospital and the European Urological Scholarship Program. TK was supported by the Oesterreichische Nationalbank Anniversary Fund (Project number: 15363/2013) and the Medical Scientific Fund of the Mayor of the City of Vienna (Project number: 14069/2014).

Conflict of interest

The authors declare no conflict of interest.

Ethical standard

This study was approved by the ethical committee of the Medical University of Vienna (Protocol registration number: 1334/2014).

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Author notes

    Authors and Affiliations

    1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, 1090, Vienna, Austria

      Ines A. Ederer, Ilaria Lucca, Sebastian L. Hofbauer, Shahrokh F. Shariat & Tobias Klatte

    2. Department of Urology, Centre hospitalier universitaire vaudois, Lausanne, Switzerland

      Ilaria Lucca

    3. Clinical Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna General Hospital, Vienna, Austria

      Michael Haidinger

    4. Clinical Institute of Pathology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria

      Andrea Haitel & Martin Susani

    5. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

      Shahrokh F. Shariat

    6. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA

      Shahrokh F. Shariat

    Authors
    1. Ines A. Ederer
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    2. Ilaria Lucca
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    3. Sebastian L. Hofbauer
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    4. Michael Haidinger
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    5. Andrea Haitel
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    6. Martin Susani
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    7. Shahrokh F. Shariat
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    8. Tobias Klatte
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    Corresponding author

    Correspondence to Tobias Klatte.

    Additional information

    Ines A. Ederer and Ilaria Lucca have contributed equally as co-first authors and are in alphabetical order.

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    Ederer, I.A., Lucca, I., Hofbauer, S.L. et al. Histopathology and prognosis of de novo bladder tumors following solid organ transplantation. World J Urol 33, 2087–2093 (2015). https://doi.org/10.1007/s00345-015-1554-z

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    • DOI: https://doi.org/10.1007/s00345-015-1554-z

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