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Oncological, functional and perioperative outcomes in transplant patients after radical prostatectomy

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Abstract

Purpose

Oncological surgery in immunosuppressed patients with solid organ transplantation (Tx) is challenging. These patients are thought to have higher postoperative morbidity and an increased rate of tumour progression. The aim of the present study was to analyse oncological, functional and perioperative outcomes in Tx patients following radical prostatectomy (RP).

Materials and methods

Between 1996 and 2014, 30 patients diagnosed with prostate cancer underwent RP at our institution following Tx (kidney: n = 20, heart: n = 5, liver: n = 5). Functional, oncological and perioperative follow-ups were analysed. Postoperative complications were assessed using the Clavien–Dindo classification.

Results

Median follow-up was 45 months. Median PSA was 5.3 ng/ml. Intraoperative blood loss was 600 ml at a median operating time of 180 min. Surgery in kidney Tx patients was technically feasible. Major complications occurred in 3 patients (ureteral injury, lymphocele and haematoma). Histological evaluation revealed n = 18 ≤pT2 tumours (60.0 %), n = 7 pT3a tumours (23.3 %) and n = 5 ≥pT3b tumours (16.7 %). Continence rate 12 months after surgery, defined as no or one safety pad use, was 73.3 %, while 93.3 % of the patients used ≤2 pads/24 h. After the median follow-up of 45 months, BCR-free survival was 69.0 %. In recurrent men, there was suspicion of metastasis in one patient. No cancer-specific death was observed. Five-year overall survival was 94.4 %.

Conclusion

The complication rate in patients with solid organ transplantation after RP was low. While histopathological evaluation revealed disease characteristics comparable to non-transplant patients from current RP series, postoperative continence was worse. Immunosuppressive therapy does not seem to lead to an increased rate of tumour progression.

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Authors contribution

B Beyer, P Mandel and D Tilki contributed to protocol and project development, data collection or management data analysis and manuscript writing and editing. U Michl, RS Pompe, V Veleva, T Steuber, H Huland and M Graefen contributed to manuscript editing.

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Author notes

    Authors and Affiliations

    1. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

      Burkhard Beyer, Uwe Michl, Raisa S. Pompe, Valia Veleva, Thomas Steuber, Hartwig Huland, Markus Graefen & Derya Tilki

    2. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

      Philipp Mandel & Derya Tilki

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    1. Burkhard Beyer
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    2. Philipp Mandel
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    3. Uwe Michl
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    4. Raisa S. Pompe
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    5. Valia Veleva
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    6. Thomas Steuber
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    7. Hartwig Huland
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    9. Derya Tilki
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    Correspondence to Derya Tilki.

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    The authors have nothing to disclose.

    Ethical standards

    All patients gave their informed consent prior to data collection. The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

    Additional information

    Burkhard Beyer and Philipp Mandel have contributed equally to this work.

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    Beyer, B., Mandel, P., Michl, U. et al. Oncological, functional and perioperative outcomes in transplant patients after radical prostatectomy. World J Urol 34, 1101–1105 (2016). https://doi.org/10.1007/s00345-015-1758-2

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    • DOI: https://doi.org/10.1007/s00345-015-1758-2

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