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Updated: Oct 19, 2025
Murine Kidney Transplant Technique
Published on: October 20, 2015
Cancer After Pediatric Kidney Transplantation: A Long-term Single-center Experience in Japan
Tomoo Yabuuchi1, Kenichiro Miura1, Satoru Shimizu2
1Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan.
Insights
Cancer risk is elevated in Japanese pediatric kidney transplant recipients compared to the general population. However, the cumulative cancer incidence was lower than previously reported, possibly due to the absence of skin cancers.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Oncology
Background:
- Limited data exists on cancer incidence in pediatric kidney transplant (KT) recipients in Asian countries.
- Previous studies have focused on cancer post-KT in Western populations.
Purpose of the Study:
- To investigate cancer incidence and risk factors in pediatric KT recipients in Japan.
- To compare cancer rates with the general Japanese population.
Main Methods:
- Analysis of children (<20 years) who underwent initial KT between 1983 and 2016.
- Comparison of cancer incidence using standardized incidence ratios.
- Examination of post-transplant cancer risk with Cox proportional hazards models.
Main Results:
- 13 cancers occurred in 12 patients (3.4%) over 4466 person-years; post-transplant lymphoproliferative disorders (PTLDs) were most common (38.5%).
- Cancer incidence was 9.9 times higher than in the general population; cumulative incidence at 20 years was 5.3%.
- Recipient Epstein-Barr virus-negative serology was an independent risk factor for cancer development.
Conclusions:
- Japanese pediatric KT recipients exhibit a higher cancer incidence than the general population.
- The observed cumulative cancer incidence was lower than in prior international studies, potentially linked to the lack of skin cancers.
- Recipient Epstein-Barr virus status is a significant factor in post-transplant cancer risk.
Background:
The cancer incidence, types, and risk factors after pediatric kidney transplantation (KT) have been reported in the United States, Canada, Europe, Australia, and New Zealand. However, no information is available about cancer in pediatric KT recipients in Asian countries.
Methods:
Children aged <20 y who underwent initial KT from 1983 to 2016 were analyzed. We compared the cancer incidence with that in the general Japanese population using standardized incidence ratio and examined posttransplant cancer risk using Cox proportional hazards models.
Results:
A total of 356 children (median age, 11.7 y; interquartile range, 5.0-17.6) received KT with a follow-up period of 4466 person-years. The median age of cancer onset was 18.5 y (interquartile range, 8.0-32.3), and 13 cancers occurred in 12 patients (3.4%). Two patients died from cancer. The most common cancers were posttransplant lymphoproliferative disorders (PTLDs) (38.5%). The median time to PTLD and non-PTLD diagnosis after KT was 0.6 and 16.4 y, respectively. There was no occurrence of skin cancer. The posttransplant cancer incidence was 9.9 times higher than that in the general age-matched population (standardized incidence ratio = 9.9; 95% confidence interval, 4.80-18.39). The cumulative cancer incidence was 5.3% in 20 y after KT, which is lower than that reported in previous studies. We could not identify any risk factors for all cancer after KT in all patients, whereas subgroup analysis in 264 patients with available data of recipient Epstein-Barr virus serological status showed that recipient Epstein-Barr virus-negative serology was an independent risk factor for cancer development.
Conclusions:
The incidence of cancer is higher in Japanese pediatric KT recipients than in the general population. The cumulative incidence of cancer after KT was lower in our population than that previously reported. This may be because there was no skin cancer observed in the Japanese pediatric KT recipients in our study.
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