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Pediatric Kidney Transplantation: Cancer and Cancer Risk
Kaitlyn E Order1, Nancy M Rodig1
1Division of Nephrology, Department of Pediatrics, Boston Children's Hospital, Boston, MA.
Insights
Pediatric kidney transplantation offers survival benefits for children with end-stage kidney disease (ESKD). However, long-term immunosuppression increases cancer risk, necessitating vigilant monitoring and prevention strategies.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Oncology
Background:
- Children with end-stage kidney disease (ESKD) require lifelong complex medical management.
- Kidney transplantation is the preferred treatment for pediatric ESKD, improving survival and quality of life.
- Long-term immunosuppression post-transplantation increases morbidity, notably cancer risk.
Purpose of the Study:
- To review cancer incidence, types, and outcomes in pediatric kidney transplant recipients.
- To discuss preventive strategies for cancer in this vulnerable population.
Main Methods:
- Literature review of studies on cancer post-pediatric kidney transplantation.
- Categorization of post-transplant cancers into lymphoproliferative disorders and solid tumors.
Main Results:
- Cancer is a significant concern in children following kidney transplantation.
- Common cancers include post-transplant lymphoproliferative disorders and non-lymphoproliferative solid tumors.
- Outcomes and specific risks vary by cancer type.
Conclusions:
- While kidney transplantation is optimal for pediatric ESKD, the associated immunosuppression poses a cancer risk.
- Understanding cancer types, incidence, and outcomes is crucial for management.
- Proactive surveillance and preventive measures are essential for improving long-term survival and health in these patients.
Abstract:
Children with end-stage kidney disease (ESKD) face a lifetime of complex medical care, alternating between maintenance chronic dialysis and kidney transplantation. Kidney transplantation has emerged as the optimal treatment of ESKD for children and provides important quality of life and survival advantages. Although transplantation is the preferred therapy, lifetime exposure to immunosuppression among children with ESKD is associated with increased morbidity, including an increased risk of cancer. Following pediatric kidney transplantation, cancer events occurring during childhood or young adulthood can be divided into two broad categories: post-transplant lymphoproliferative disorders and non-lymphoproliferative solid tumors. This review provides an overview of cancer incidence, types, outcomes, and preventive strategies in this population.
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