Long-Term Risk of Cancer in Survivors of Pediatric ESRD

Abstract

Background and objectives ESRD is associated with an increased risk of malignancies. We analyzed the incidence of cancer in patients with pediatric ESRD after long-term follow-up.Design, setting, participants, & measurements All Dutch patients born before 1979 who were transplanted at age ,15 years old in 1972-1992 were followed until 2010. We explored type and incidence of malignancies in patients compared with the general population using the National Cancer Registry.Results After a median of 25.3 years (1.3-37.8) of transplantation and at a median age of 33.5 years old (11.0-49.0), 105 primary malignancies had occurred in 54 of 249 patients. Among them, cutaneous squamous cell carcinoma was most frequent. Patients ages 25-30 years old had developed 16.5 times (95% confidence interval, 7.9 to 34.6) as many de novo tumors and 991 times (95% confidence interval, 313 to 3137) as many de novo cutaneous squamous cell carcinomas as their general population counterparts; in survivors ages 45-50 years old, these numbers were 81.5 (95% confidence interval, 50.7 to 131.1) and 2610 (95% confidence interval, 1596 to 4267), respectively. Cumulative incidence competing risk analysis showed that, after 30 years of transplantation, 41% of the survivors had developed cancer; 31% had developed a second de novo cancer ,1 year after initial cancer diagnosis.Conclusions Cancer is highly prevalent among patients with pediatric ESRD after 25.3 years of transplantation, with a high rate of recurrence.

TFE3‐positive renal cell carcinoma occurring in three children with dysfunctional kidneys on immunosuppression

“…Transplant recipients experience worse cancer‐related outcomes than the general population . Following kidney transplantation, RCC is the most common solid malignancy, with a 15‐100× increased risk compared to the general population, and occurring in native kidneys in 80% of cases . The overall incidence of RCC occurring in native kidneys of adult renal transplant patients varies between 0.3% and 4.8% .…”

“…12 Following kidney transplantation, RCC is the most common solid malignancy, with a 15-100× increased risk compared to the general population, and occurring in native kidneys in 80% of cases. [13][14][15][16] The overall incidence of RCC occurring in native kidneys of adult renal transplant patients varies between 0.3% and 4.8%. 6 Risk factors include age greater than 65, male gender, African American ethnicity, a longer pretransplant dialysis interval, and history of cystic kidney disease.…”

Does HLA matching matter in the modern era of renal transplantation?

“…Morbidity and mortality are now mainly due to side effects of immunosuppression rather than renal failure itself [5,38]. The cumulative incidence of cancers becomes significantly high after 25 years of transplant life; 27% for all cancers in the ANZDATA cohort and 22% in one Dutch study [39,40]. In addition, 30% develop a second cancer within 2 years of the first cancer [40].…”

Survival in children requiring chronic renal replacement therapy

“…In The Netherlands, 30 years after pediatric transplantation, 41% of survivors had developed cancer and 31% a second de novo cancer during the first year after initial diagnosis. Malignancies were responsible for 13% of all deaths in the cohort, and overall, malignancy was >20-fold higher than in the general population, with a notable increase in risk starting after 20 years of follow-up [ 93 ].…”