Abstract: TH-PO1045
Early De Novo Bladder Malignancy in a Kidney Transplant Recipient
Session Information
- Transplantation: Clinical - Outcomes, Malignancy, and Pathology
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Nasr, Ujala, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
- Shenoy, Prashamsa, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
Introduction
Early de novo malignancies after kidney transplantation are rare, with an incidence of <10% in the first year. The most common early de novo malignancy in kidney transplant recipients is post-transplant lymphoproliferative disorder (PTLD) (26%), followed by bladder cancer (18%). While patients are routinely screened for PTLD risk both pre and post-transplant, there is currently no standard screening for bladder cancer.
Case Description
A 79-year-old man underwent a preemptive living donor kidney transplant with basiliximab induction and was maintained on tacrolimus and mycophenolate. Ten months post transplant he was admitted with an episode of acute diverticulitis. A CT scan of the abdomen/pelvis, performed to evaluate for a diverticular abscess, incidentally revealed a 17 × 20 mm intraluminal, mural-based mass along the posterior wall of the urinary bladder, suspicious for malignancy. Cystoscopic evaluation with biopsy confirmed high-grade papillary urothelial carcinoma of the bladder.
His risk factors included advanced age, type 2 diabetes mellitus, prior smoking history (7 pack years) and low-intensity immunosuppression. There was no history of cyclophosphamide exposure/ BK polyomavirus infection. The donor remained well without any malignancy. The patient was asymptomatic, with no painless gross hematuria, urinary symptoms, pelvic pain, or weight loss. Retrospective chart review showed no microscopic hematuria on urinalysis or urine microscopy before or after transplantation. A cystoscopy performed at the time of ureteral stent removal at 1-month post-transplant had no evidence of abnormal bladder tissue. Immunosuppression was lowered, and he was treated with intravesical gemcitabine and docetaxel, achieving good response while maintaining stable allograft function.
Discussion
Bladder cancer is the 2nd most common early de novo malignancy in kidney transplant recipients, typically recipient-derived, with a usual latency of 5–10 years post-transplant. Despite a 3-fold increased risk with immunosuppression, routine screening for bladder cancer is currently not a part of standard pre-transplant evaluation (low yield). However, given the rapid progression of this tumor, we emphasize the need for risk stratification of the screening process. Additionally emerging immunotherapies pose a new challenge for prevention of allograft rejection.