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.

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

Figure 1.

Cumulative incidence competing risk of de novo malignancy. (A) Cumulative incidence competing risk of de novo malignancy in patients with pediatric transplants. (B) Cumulative incidence competing risk of de novo malignancy in survivors of pediatric transplantation. (C) Cumulative incidence competing risk of developing a second de novo malignancy in patients with pediatric transplants. (D) Cumulative incidence competing risk of developing a second de novo malignancy in survivors of pediatric transplantation.

Figure 1.

Cumulative incidence competing risk of de novo malignancy. (A) Cumulative incidence competing risk of de novo malignancy in patients with pediatric transplants. (B) Cumulative incidence competing risk of de novo malignancy in survivors of pediatric transplantation. (C) Cumulative incidence competing risk of developing a second de novo malignancy in patients with pediatric transplants. (D) Cumulative incidence competing risk of developing a second de novo malignancy in survivors of pediatric transplantation.