SAN FRANCISCO—Renal transplant recipients and non-transplant patients with end-stage renal disease (ESRD) who develop bladder cancer have more extensive disease distribution at diagnosis than bladder cancer patients in the general population, according to researchers. The disease distribution between the transplant and ESRD patients is similar, however.


Investigators at the University of Virginia Health System in Charlottesville, Va., used the Surveillance Epidemiology and End Results (SEER)-Medicare database to identify all cases of bladder cancer diagnosed from 1988 to 2003.

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In addition, they identified 58 patients who had renal transplant surgery before being diagnosed with bladder cancer and 400 patients with ESRD who did not undergo renal transplantation prior to their bladder cancer diagnosis. The study population also included 97,484 bladder cancer patients without ESRD or a renal transplant (general population).


Bladder cancer was diagnosed at a significantly younger age in the renal transplant recipients than the ESRD group and the patients without ESRD or a transplant (mean age 54.6 years vs. 71.1 and 72.7 years, respectively). The investigators, led by Behfar Ehdaie, MD, observed a mean duration of 5.2 years between renal transplantation and bladder cancer diagnosis. They reported study findings here at the 2008 Genitourinary Cancers Symposium.


At bladder cancer diagnosis, muscle-invasive disease (T2 or higher) was present in 36.7% and 33.2% of renal transplant and ESRD patients compared with 24.2% of the general population. Superficial disease (less than T2) was present in 63.3% and 66.8% of the transplant and ESRD groups, respectively, compared with 75.8% of the general population.


Additionally, the transplant and ESRD patients had significantly higher proportions of non-transitional cell histology than the group without transplants or ESRD (17.2% and 11.8% vs. 6.5%).


The researchers said their cohort of renal transplant patients who developed bladder cancer is the largest reported to date.