Long‐term outcomes of pediatric kidney transplant recipients with a pretransplant malignancy

Abstract

A childhood malignancy can rarely progress to ESRD requiring a KT. To date, few reports describe long‐term outcomes of pediatric KT recipients with a pretransplant malignancy. Between 1963 and 2015, 884 pediatric (age: 0‐17 years old) recipients received 1055 KTs at our institution. KT outcomes were analyzed in children with a pretransplant malignancy. We identified 14 patients who had a pretransplant malignancy prior to KT; the majority were <10 years old at the time of KT. Ten (71%) patients received their grafts from living donors, the majority of which were related to the recipient. Wilms' tumor was the dominant type of pretransplant malignancy, seen in 50% of patients. The other pretransplant malignancy types were EBV‐positive lymphoproliferative disorders, non‐EBV‐positive lymphoma, leukemia, neuroblastoma, soft‐tissue sarcoma, and ovarian cancer. Ten of the 14 patients received chemotherapy as part of their pretransplant malignancy treatment. Graft survival at 1, 3, and 5 years was 93%, 83%, and 72%, respectively. Patient survival at 1, 5, and 10 years was 100%, 91%, and 83%, respectively. Six (40%) patients suffered AR following KT; half of them had their first episode of AR within 1 month of KT. Our single‐center experience demonstrates that pediatric KT recipients with a previously treated pretransplant malignancy did not exhibit worse outcomes than other pediatric KT patients.

Nonhepatic Cancer in the Pediatric Liver Transplant Population: Guidelines From the ILTS-SETH Consensus Conference

“…The risk of recurrence was however lower (2.7%–13.8%) after pediatric liver or kidney transplant in highly selected patients. 16,17 The “ideal” latency period between cancer resolution and transplantation remains undefined.…”

Syndromic Wilms tumor: a review of predisposing conditions, surveillance and treatment

“…Should a patient develop end stage renal disease, either from nephrectomy(ies), dysplasia, or chemotherapy toxicity, he or she should expect similar outcomes to transplant recipients who do not have a history of malignancy (53,63). Typically, transplant is delayed at least 1 year after treatment for WT is completed (16,53,(63)(64)(65)(66).…”

“…Should a patient develop end stage renal disease, either from nephrectomy(ies), dysplasia, or chemotherapy toxicity, he or she should expect similar outcomes to transplant recipients who do not have a history of malignancy (53,63). Typically, transplant is delayed at least 1 year after treatment for WT is completed (16,53,(63)(64)(65)(66). Although post-transplant malignancies occur in WT patients rarely (53,63,65), special consideration should be given to those with syndromes that also predispose to other malignancies.…”

“…Typically, transplant is delayed at least 1 year after treatment for WT is completed (16,53,(63)(64)(65)(66). Although post-transplant malignancies occur in WT patients rarely (53,63,65), special consideration should be given to those with syndromes that also predispose to other malignancies. Recurrences in native kidneys have been reported following renal transplantation, thus completion nephrectomy prior to transplant and immunosuppression is recommended for patients who previously underwent nephron-sparing (65,67).…”