Management of de-novo urothelial carcinoma in transplanted patients

TY - JOUR

T1 - Management of de-novo urothelial carcinoma in transplanted patients

AU - Pradere, Benjamin

AU - Schuettfort, Victor

AU - Mori, Keiichiro

AU - Quhal, Fahad

AU - Aydh, Abdulmajeed

AU - Sari Motlagh, Reza

PY - 2020/5

Y1 - 2020/5

N2 - PURPOSE OF REVIEW: The aim of this article is to review incidence, risk factors, and optimal management of de-novo urothelial carcinoma in transplant recipients.RECENT FINDINGS: There is a two to three-fold increased risk for de-novo malignant tumors after solid-organ transplantation, but there is currently no consensus regarding optimal management of de-novo urothelial carcinoma in transplanted patients. Known risk factors include polyomavirus BK, aristolochic acid, and smoking. Data suggest a higher rate of high-grade tumors, as well as predominantly higher stage at primary diagnosis, for both NMIBC and muscle-invasive bladder cancer (MIBC). Treatment for NMIBC includes TURB, mitomycin, and Bacille de Calmette-Guérin instillation with special concern to the immunosuppressive regime. Treatment of MIBC or advanced urothelial carcinoma includes radical cystectomy with chemotherapy if the patient is eligible. A screening should be performed in all transplant recipients, to allow early diagnosis.SUMMARY: De-novo urothelial carcinoma in transplant recipients is more frequent than in the general population and these tumors were more likely to be high-grade tumors and diagnosed at an advanced stage. There is very little information available on the optimal treatment for these patients. However, aggressive treatment and a strict management according the given recommendations are of the utmost importance.

AB - PURPOSE OF REVIEW: The aim of this article is to review incidence, risk factors, and optimal management of de-novo urothelial carcinoma in transplant recipients.RECENT FINDINGS: There is a two to three-fold increased risk for de-novo malignant tumors after solid-organ transplantation, but there is currently no consensus regarding optimal management of de-novo urothelial carcinoma in transplanted patients. Known risk factors include polyomavirus BK, aristolochic acid, and smoking. Data suggest a higher rate of high-grade tumors, as well as predominantly higher stage at primary diagnosis, for both NMIBC and muscle-invasive bladder cancer (MIBC). Treatment for NMIBC includes TURB, mitomycin, and Bacille de Calmette-Guérin instillation with special concern to the immunosuppressive regime. Treatment of MIBC or advanced urothelial carcinoma includes radical cystectomy with chemotherapy if the patient is eligible. A screening should be performed in all transplant recipients, to allow early diagnosis.SUMMARY: De-novo urothelial carcinoma in transplant recipients is more frequent than in the general population and these tumors were more likely to be high-grade tumors and diagnosed at an advanced stage. There is very little information available on the optimal treatment for these patients. However, aggressive treatment and a strict management according the given recommendations are of the utmost importance.

KW - Carcinoma, Transitional Cell/pathology

KW - Cystectomy

KW - Humans

KW - Kidney Transplantation/adverse effects

KW - Transplant Recipients

KW - Urinary Bladder Neoplasms/pathology

KW - Urothelium/pathology

U2 - 10.1097/MOU.0000000000000749

DO - 10.1097/MOU.0000000000000749

M3 - SCORING: Review article

C2 - 32235285

VL - 30

SP - 467

EP - 474

JO - CURR OPIN UROL

JF - CURR OPIN UROL

SN - 0963-0643

IS - 3

ER -