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. 2017 May;139(5):e20163893.
doi: 10.1542/peds.2016-3893.

Cancer Risk After Pediatric Solid Organ Transplantation

Elizabeth L Yanik  1 , Jodi M Smith  2 , Meredith S Shiels  3 , Christina A Clarke  4 , Charles F Lynch  5 , Amy R Kahn  6 , Lori Koch  7 , Karen S Pawlish  8 , Eric A Engels  3
Affiliations

Cancer Risk After Pediatric Solid Organ Transplantation

Elizabeth L Yanik et al. Pediatrics. 2017 May.

Abstract

Background: The effects of pediatric solid organ transplantation on cancer risk may differ from those observed in adult recipients. We described cancers in pediatric recipients and compared incidence to the general population.

Methods: The US transplant registry was linked to 16 cancer registries to identify cancer diagnoses among recipients <18 years old at transplant. Standardized incidence ratios (SIRs) were estimated by dividing observed cancer counts among recipients by expected counts based on the general population rates. Cox regression was used to estimate the associations between recipient characteristics and non-Hodgkin's lymphoma (NHL) risk.

Results: Among 17 958 pediatric recipients, 392 cancers were diagnosed, of which 279 (71%) were NHL. Compared with the general population, incidence was significantly increased for NHL (SIR = 212, 95% confidence interval [CI] = 188-238), Hodgkin's lymphoma (SIR = 19, 95% CI = 13-26), leukemia (SIR = 4, 95% CI = 2-7), myeloma (SIR = 229, 95% CI = 47-671), and cancers of the liver, soft tissue, ovary, vulva, testis, bladder, kidney, and thyroid. NHL risk was highest during the first year after transplantation among recipients <5 years old at transplant (SIR = 313), among recipients seronegative for Epstein-Barr virus (EBV) at transplant (SIR = 446), and among intestine transplant recipients (SIR = 1280). In multivariable analyses, seronegative EBV status, the first year after transplantation, intestine transplantation, and induction immunosuppression were independently associated with higher NHL incidence.

Conclusions: Pediatric recipients have a markedly increased risk for many cancers. NHL constitutes the majority of diagnosed cancers, with the highest risk occurring in the first year after transplantation. NHL risk was high in recipients susceptible to primary EBV infection after transplant and in intestine transplant recipients, perhaps due to EBV transmission in the donor organ.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Clarke is employed by GRAIL, Inc and has received grant funding from Genentech; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
SIRs for cancer among US pediatric transplant recipients. Diamonds represent the point estimates for each SIR. Vertical error bars represent the 95% CIs for each SIR.
See this image and copyright information in PMC

Comment in

  • Transplanting One Problem for Another.
    Borst AJ, Wechsler DS. Borst AJ, et al. Pediatrics. 2017 May;139(5):e20170542. doi: 10.1542/peds.2017-0542. Pediatrics. 2017. PMID: 28557771 Free PMC article. No abstract available.

References

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