Kidney disease and transplantation in childhood cancer survivors

Advancements in pediatric cancer treatment protocols have significantly improved long-term survival. This has been accompanied by a growing recognition of morbidity and mortality associated with late effects of treatment, including kidney disease. Surviving cancer in childhood implies exposure to multiple nephrotoxic insults, some of which carry a greater risk for the development of chronic kidney disease and progression to kidney failure than others. In childhood cancer survivors who develop kidney failure, a kidney transplant is a potential life-prolonging treatment option. However, the optimal timing of transplant in relation to remission, particularly when weighing morbidity associated with increased time on dialysis against the risk of cancer recurrence associated with transplant immunosuppression, remains controversial. This review explores nephrotoxicity and kidney-related complications of cancer treatment, kidney disease screening guidelines, and considerations for kidney transplant in childhood cancer survivors including timing from remission to transplant, cancer recurrence in the setting of post-transplant immunosuppression, and transplant outcomes.