Long-Term Risk of Cancer in Survivors of Pediatric ESRD

Clin J Am Soc Nephrol. 2015 Dec 7;10(12):2198-204. doi: 10.2215/CJN.03630415. Epub 2015 Oct 1.

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.

Keywords: cancer; carcinoma; child; end-stage renal disease; follow-up studies; kidney failure, chronic; neoplasms; renal insufficiency, chronic; renal transplantation; squamous cell; survivors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Humans
  • Incidence
  • Infant
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / therapy*
  • Kidney Transplantation / adverse effects
  • Middle Aged
  • Neoplasms / diagnosis
  • Neoplasms / epidemiology*
  • Neoplasms / mortality
  • Neoplasms / therapy
  • Netherlands / epidemiology
  • Prevalence
  • Renal Replacement Therapy / adverse effects*
  • Renal Replacement Therapy / mortality
  • Risk Assessment
  • Risk Factors
  • Survivors*
  • Time Factors
  • Young Adult