Elevated Risk of Cancer After Solid Organ Transplant in Childhood: A Population-based Cohort Study

Kitchlu, Abhijat; Dixon, Stephanie N.; Dirk, Jade; Chanchlani, Rahul; Vasilevska-Ristovska, Jovanka; Borges, Karlota; Dipchand, Anne I.; Ng, Vicky L.; Hébert, Diane; Solomon, Melinda; Paterson, J Michael; Gupta, Sumit; Kim, S Joseph; Nathan, Paul C.; Parekh, Rulan S.

doi:10.1097/tp.0000000000002378

Cited by 25 publications

(68 citation statements)

References 38 publications

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“…11 Other studies have demonstrated similar findings, with PTLD and skin cancers being the most commonly reported malignancies in pediatric transplant recipients. [12][13][14] Strategies to prevent these malignancies such as minimization of immunosuppression through steroid withdrawal and constant vigilance in reducing either CNI levels and/or antimetabolite dosages are actively employed.…”

Section: The Burden Of Immunosuppressionmentioning

confidence: 99%

<p>Improving Patient Outcomes Following Pediatric Liver Transplant: Current Perspectives</p>

Cuenca¹,

Yeh²

2019

TRRM

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Over the last 50 years, considerable advances have been made in pediatric liver transplantation. The long-term 10-year patient and graft survival following pediatric liver transplant have improved considerably to greater than 90% and 75%, respectively. With longer living grafts, patients are now struggling with different issues, such as the consequences and morbidity of immunosuppression and/or chronic hospitalization. This review will discuss some of the current outcomes and obstacles in pediatric liver transplantation, such as sequelae of long-term maintenance immunosuppression, worsened neurocognitive development, and shortages in allografts that lead to waitlist mortality. Though the future is bright and certainly better than it once was, there are clearly areas of in the long-term clinical care of these patients that deserve focus and attention. This review will highlight some of these concepts, as well as novel strategies to treat and address some of these issues in this complex and fragile patient population.

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Section: The Burden Of Immunosuppressionmentioning

confidence: 99%

<p>Improving Patient Outcomes Following Pediatric Liver Transplant: Current Perspectives</p>

Cuenca¹,

Yeh²

2019

TRRM

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“…Renal cancer after transplantation is not uncommon and is thought to most often occur within the first year of organ procurement, likely in the setting of immunosuppression. In a Canadian study, following 951 pediatric solid organ recipients, of which 400 were kidney recipients, average time to development of cancer was 5 years . 25 of the 400 kidney recipients (6%) went on to develop cancers in this study .…”

Section: Discussionmentioning

confidence: 64%

“…In a Canadian study, following 951 pediatric solid organ recipients, of which 400 were kidney recipients, average time to development of cancer was 5 years. 8 25 of the 400 kidney recipients (6%) went on to develop cancers in this study. 8 In the United States, malignancy is the second cause of death among recipients of kidney transplants with about 5% of these cases being kidney cancer and 10% of the kidney cancers arising in the renal graft itself.…”

Section: Discussionmentioning

confidence: 79%

“…8 25 of the 400 kidney recipients (6%) went on to develop cancers in this study. 8 In the United States, malignancy is the second cause of death among recipients of kidney transplants with about 5% of these cases being kidney cancer and 10% of the kidney cancers arising in the renal graft itself. 9 Therefore, we consider our patient to be at greater risk of malignancy than an otherwise healthy patient with MEST.…”

Section: Discussionmentioning

confidence: 79%

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Mixed epithelial and stromal tumor after pediatric kidney transplant

Ferdjallah

Gordon

Kirankumar

et al. 2019

Pediatric Transplantation

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MEST of the kidney are a benign group of tumors with very rare incidence of malignant transformation. First described in 1998, this tumor has never been reported in a transplanted organ before. We present a unique case of de novo MEST in a donor kidney 4 years after transplant into a pediatric patient. Although removal of the lesions is curative without risking malignant transformation, in this case, surgical removal was not attempted to prevent reduction in transplant longevity. In this unique report of MEST in a transplanted kidney, we describe the patient/transplant outcomes without MEST resection.

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“…Solid organ transplant (SOT) recipients are at increased risk for malignancies in both pediatric and adult populations (1)(2)(3), with an elevated risk of dying of their cancer, even after adjustment for stage and treatment (4). Pediatric and adult kidney transplant (KT) recipients carry similar risk and malignancies are third most common cause of mortality within this population (5,6).…”

Section: Introductionmentioning

confidence: 99%

Human Papillomavirus Vaccination in Male and Female Adolescents Before and After Kidney Transplantation: A Pediatric Nephrology Research Consortium Study

et al. 2020

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Background: Kidney transplant (KT) recipients have higher incidence of malignancies, including Human Papillomavirus (HPV)-associated cancers. Thus, HPV vaccines may have an important role in preventing HPV-related disease in this population; however, immunogenicity and safety data are lacking. Objective: To examine the immunological response and tolerability to HPV vaccination in pediatric KT recipients compared to future KT candidates. Methods: The quadrivalent HPV vaccine was administered to girls and boys age 9-18 recruited from seven centers part of the Pediatric Nephrology Research Consortium. Subjects were recruited for three groups: (1) CKD: chronic kidney disease stages 3, 4, and 5 not on dialysis; (2) Dialysis; (3) KT recipients. The outcome consisted of antibody concentrations against HPV 6, 11, 16, and 18. Geometric mean titers (GMTs) and seroconversion rates were compared. Vaccine tolerability was assessed. Results: Sixty-five participants were recruited: 18 in the CKD, 18 in the dialysis, and 29 into the KT groups. KT patients had significantly lower GMTs after vaccination for all serotypes. The percentages of subjects who reached seroconversion were overall lower for the KT group, reaching statistical significance for HPV 6, 11, and 18. Comparing immunosuppressed subjects (anyone taking immunosuppression medications, whether KT recipient or not) with the non-immunosuppressed participants, the former had significantly lower GMTs for all the HPV serotypes and lower seroconversion rates for HPV 6, 11, and 18. KT females had higher GMTs and seroconversion rates for certain serotypes. There were no adverse events in either group. Conclusions: HPV vaccine was well-tolerated in this population. Pediatric KT recipients had in general lower GMTs and seroconversion rates compared to their peers with CKD Nailescu et al. HPV Vaccination in Pediatric Nephrology or on dialysis. Immunosuppression played a role in the lack of seroconversion. Our results emphasize the importance of advocating for HPV vaccination prior to KT and acknowledge its safety post transplantation. Future studies are needed to investigate the effect of a supplemental dose of HPV vaccine in KT recipients who do not seroconvert and to evaluate the long-term persistence of antibodies post-KT.

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Elevated Risk of Cancer After Solid Organ Transplant in Childhood: A Population-based Cohort Study

Abstract: Childhood transplant recipients have a 30-times greater cancer incidence versus the general population. Further investigation is needed to guide screening strategies in this at-risk population.

Cited by 25 publications

References 38 publications

<p>Improving Patient Outcomes Following Pediatric Liver Transplant: Current Perspectives</p>

<p>Improving Patient Outcomes Following Pediatric Liver Transplant: Current Perspectives</p>

Mixed epithelial and stromal tumor after pediatric kidney transplant

Human Papillomavirus Vaccination in Male and Female Adolescents Before and After Kidney Transplantation: A Pediatric Nephrology Research Consortium Study

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