Cancer Risk After Pediatric Solid Organ Transplantation

Area of Science:

• Oncology
• Transplantation Medicine
• Pediatric Health

Background:

• Cancer risk in pediatric solid organ transplant recipients may differ from adults.
• This study describes cancers in pediatric recipients and compares incidence to the general population.

Purpose of the Study:

• To investigate cancer incidence in pediatric solid organ transplant recipients.
• To compare cancer risks in pediatric recipients to the general population.
• To identify risk factors for non-Hodgkin's lymphoma (NHL) in this population.

Main Methods:

• Linked US transplant registry data with 16 cancer registries for recipients <18 years old at transplant.
• Calculated standardized incidence ratios (SIRs) by comparing observed to expected cancer counts.
• Used Cox regression to analyze associations between recipient characteristics and NHL risk.

Main Results:

• 392 cancers diagnosed in 17,958 pediatric recipients; 71% were NHL.
• Significantly increased incidence for NHL (SIR=212), Hodgkin's lymphoma (SIR=19), leukemia (SIR=4), myeloma (SIR=229), and other specific cancers.
• Highest NHL risk in the first year post-transplant, in recipients <5 years old, seronegative for Epstein-Barr virus (EBV), and undergoing intestine transplantation.

Conclusions:

• Pediatric transplant recipients have a markedly elevated risk for multiple cancers, with NHL being the most common.
• The first year post-transplant presents the highest NHL risk.
• Primary EBV infection susceptibility and intestine transplantation are associated with increased NHL risk, potentially due to EBV transmission.