Polyomavirus Replication and Smoking Are Independent Risk... : Transplantation (original) (raw)

Original Clinical Science—General: Infection

Polyomavirus Replication and Smoking Are Independent Risk Factors for Bladder Cancer After Renal Transplantation

Liu, Sandy MD1; Chaudhry, Muhammad R. MD, MPH1; Berrebi, Alexander A. MD1; Papadimitriou, John C. MD, PhD1; Drachenberg, Cinthia B. MD1; Haririan, Abdolreza MD, MPH2; Alexiev, Borislav A. MD1

1 Department of Pathology, University of Maryland School of Medicine, Baltimore, MD.

2 Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.

Received 11 November 2015. Revision received 22 February 2016.

Accepted 18 March 2016.

The authors declare no funding or conflicts of interest.

S.L. drafted the article, collected the patient's clinical and pathologic report data, and performed statistical analysis. M.R.C. collected the patient's clinical data. A.A.B. collected the patient's clinical data. A.H. reviewed treatment protocols and revised the article. J.C.P. collected the patient's clinical data, revised the article, and contributed to the study design. C.B.D. collected the patient's clinical data, revised the article, and contributed to the study design. B.A.A. collected the patient's clinical data, revised the article, and contributed to the study design.

Correspondence: Borislav A. Alexiev, MD, Department of Pathology, NBW56, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD 21201. ([email protected]).

Background

Solid organ transplant recipients are at increased risk for developing malignancies. Polyomaviruses (PV) have been historically associated with experimental tumor development and recently described in association with renourinary malignancies in transplant patients. The aim of this study was to investigate the relationship between PV replication and smoking, and the development of malignant neoplasms in kidney transplant recipients.

Methods

A retrospective case-control study was conducted for PV replication in all kidney biopsies and urine cytologies performed between 1998 and 2014 from kidney transplant recipients at the University of Maryland Medical Center. Polyomavirus-positive patients (n = 943) were defined as having any of the following: a kidney biopsy with PV associated nephropathy, any urine cytology demonstrating “decoy” cells, and/or significant polyomavirus BK viremia. Polyomavirus-negative matched patients (n = 943) were defined as lacking any evidence of PV replication. The incidence of malignancy (excluding nonmelanoma skin tumors) was determined in these 1886 patients and correlated with demographic data and history of smoking.

Results

There was a 7.9% incidence of malignant tumors after a mean posttransplant follow-up of 7.9 ± 5.4 years. Among all cancer subtypes, only bladder carcinoma was significantly associated with PV replication. By multivariate analysis, only PV replication and smoking independently increased the risk of bladder cancer, relative risk, 11.7 (P = 0.0013) and 5.6 (P = 0.0053), respectively.

Conclusions

The findings in the current study indicate that kidney transplant recipients with PV replication and smoking are at particular risk to develop bladder carcinomas and support the need for long-term cancer surveillance in these patients.