Risk factors, incidence, and outcomes of bladder and ureteral cancer in lung transplant recipients: A single-center cohort study.

Background: Lung transplant recipients (LTRs) are at increased risk of genitourinary cancers (GUCs) but do not undergo routine surveillance. This study describes the cumulative incidence and clinical outcomes of GUC among LTRs. Methods: This single-center, retrospective cohort study included all adult LTRs transplanted between 2010 and 2020 with histologically confirmed posttransplant bladder or ureteral cancer. The primary outcome was the cumulative incidence (CI) of GUC. We estimated the subdistribution hazard ratio (sHR) for GUC using a competing risks proportional hazards model. Secondary outcomes, including survival after GUC diagnosis, were analyzed using Kaplan-Meier curves and the log-rank test for comparisons. Statistical significance was set at Results: Among 835 LTRs, 15 developed posttransplant GUC (13 bladder and 2 ureteral); 11 were diagnosed >5 years post-LT. The CI was 1.8%. The cohort was predominantly male (73.3%) with a median age of 72.5 years (IQR 68-77.8) and substantial tobacco exposure (≥20 pack-years: 93.3%). GUC was diagnosed at a median of 75 months (IQR 52.1-103.6) posttransplant. Mortality was high (73.3% deceased at follow-up) with a median survival of 196 days after GUC diagnosis. Obstructive lung disease (OLD) was associated with a markedly higher subdistribution hazard of posttransplant GUC (sHR: 4.99 [ Conclusions: GUCs were rare but clinically important late complications after LT, frequently presented with aggressive features, and were associated with poor survival. The association with OLD should be interpreted cautiously given the small number of events and potential confounding by cumulative tobacco exposure. These findings support further study of risk-adapted surveillance strategies in higher-risk LTRs.