Noninvasive Bladder Cancer Treated with Bacillus Calmette-Guérin in Kidney Transplant Recipients

Introduction: Bacillus Calmette-Guérin (BCG) is best known as one of the discoveries for the protection against tuberculosis, which also was noted to have other benefits, such as a therapy for non-muscle invasive bladder cancer (NMIBC). In immunosuppressed patients, the use of BCG developed concerns because the creation was derived from being a re-culture of Mycobacterium bovis. The few cases found during literature review discussed the complications of intravesical BCG therapy in kidney transplant patients, such as subacute interstitial pneumonitis and disseminated Mycobacterium bovis infection. We have four cases of kidney transplant recipients who were treated with intravesical BCG therapy for NMIBC with no post-treatment complications. Case Description: A 67-year-old man with history of pre-emptive kidney transplant due to autosomal dominant polycystic kidney disease (ADPKD) in 2022 and high-grade noninvasive papillary urothelial carcinoma (PUC) in 1988 status post (s/p) transurethral resection of bladder tumor (TURBT) in 1998 treated with intravesical BCG in 2019 due to recurrence. A 49-year-old man with history of renal transplant due to end-stage kidney disease (ESKD) caused by autosomal 17q12 microdeletion syndrome in 2005 and high-grade noninvasive PUC s/p TURBT in 2019 treated with intravesical BCG in late 2019. A 67-year-old man with history of kidney transplant due to ESKD from type one diabetes mellitus and hypertension early 2017 (previously on dialysis) and low-grade noninvasive PUC s/p TURBT in late 2017 treated with intravesical BCG therapy in 2019 due to recurrence. A 66-year-old man with history of renal transplant due to ESKD from focal segmental glomerulosclerosis (FSGS) in 1995 and high-grade noninvasive PUC s/p TURBT in 2017 treated with intravesical BCG in late 2017. Discussion: All four cases did not exhibit post-treatment complications and are currently doing well. These cases depict that use of intravesical BCG may be safe for patients taking immunosuppression.