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BK-Associated Urothelial Cancer — RACP Adult Medicine MCQ

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HardNephrologyBK-Associated Urothelial CancerRACP Adult Medicine

A 60-year-old renal transplant recipient presents with painless haematuria. He has been on immunosuppression for 15 years. Cystoscopy shows a papillary bladder tumour. Biopsy confirms urothelial carcinoma (transitional cell carcinoma). He had BK virus nephropathy 5 years ago. What is the most likely associated risk factor?

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Correct answer: E — Post-transplant lymphoproliferative disorder

This question's option set doesn't well match the clinical answer. The key teaching point: chronic immunosuppression increases risk of multiple cancers. BK polyomavirus has been associated with urothelial carcinoma in transplant recipients (BKV DNA found in tumour tissue). Treatment follows standard urothelial cancer guidelines. Immunosuppression reduction is considered. [Note: among options, PTLD is a general post-transplant malignancy marker but the specific answer is BK-associated urothelial cancer]

Reference: TSANZ – 2024 – Post-Transplant Cancer; KDIGO 2024