Treatments and outcomes for end-stage renal disease following Wilms tumor

Pediatr Nephrol. 2012 Aug;27(8):1325-33. doi: 10.1007/s00467-012-2140-x. Epub 2012 Mar 20.

Abstract

Background: Little is known about treatment outcomes for children who have end-stage renal disease (ESRD) after treatment for Wilms tumor (WT).

Methods: Time-to-transplant, graft failure, and survival outcomes were examined for 173 children enrolled on the National Wilms Tumor Study who developed ESRD.

Results: Fifty-five patients whose ESRD resulted from progressive bilateral WT (PBWT) experienced high early mortality from WT that limited their opportunity for transplant (47% at 5 years) and survival (44% at 10 years) in comparison to population controls. The 118 patients whose ESRD was due to other causes (termed "chronic kidney disease"), many of whom had WT-associated congenital anomalies, had transplant (77% at 5 years) and survival (73% at 10 years) outcomes no worse than those for population controls. Graft failure following transplant was comparable for the two groups. Minority children had twice the median time to transplant as non-Hispanic whites and twice the mortality rates, also reflecting population trends.

Conclusions: In view of the continuing high mortality in patients with ESRD, and the dramatic improvement in outlook following kidney transplantation, re-evaluation of current guidelines for a 2-year delay in transplant following WT treatment may be warranted.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Graft Survival
  • Humans
  • Infant
  • Infant, Newborn
  • Kidney Failure, Chronic / etiology*
  • Kidney Failure, Chronic / mortality*
  • Kidney Failure, Chronic / surgery
  • Kidney Neoplasms / complications*
  • Kidney Neoplasms / surgery
  • Kidney Transplantation / mortality*
  • Male
  • Survival Analysis
  • Treatment Outcome
  • Wilms Tumor / complications*
  • Wilms Tumor / surgery