Malignancies after pediatric solid organ transplantation
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EDUCATIONAL REVIEW
Malignancies after pediatric solid organ transplantation Cal Robinson 1,2 & Rahul Chanchlani 3,4,5 & Abhijat Kitchlu 6 Received: 22 May 2020 / Revised: 28 July 2020 / Accepted: 18 September 2020 # IPNA 2020
Abstract As life expectancy among pediatric solid organ transplant recipients (SOTRs) improves, the risk of comorbid conditions such as malignancy post-transplantation has also increased. SOTRs are at elevated risks of post-transplantation lymphoproliferative disorders (PTLDs), and skin and solid cancers. PTLDs typically occur early following transplantation, while skin and solid cancers frequently arise in young adulthood (25–40 years). By 30 years following transplantation, 26–41% of pediatric SOTRs have developed cancer. Different risk factors exist for PTLD, and skin and solid cancers, which are modified by cumulative immunosuppression, infections, transplanted organ, and the underlying disease process associated with initial organ failure (e.g., kidney failure). Optimal cancer treatment strategies depend on the specific cancer type, stage, and patient comorbidities. Immunosuppression reduction may be beneficial for certain cancers but must be considered against the risks of acute and chronic rejection and allograft loss. Lifestyle counseling regarding smoking avoidance and sun protection, as well as human papillomavirus vaccination, is an important aspect of cancer prevention. Currently, no cancer screening guidelines exist specifically for pediatric SOTRs. Adult population screening guidelines have not been validated in transplant populations. Therefore, an individualized approach should be taken to cancer screening for pediatric SOTRs, accounting for other cancer risk factors. Keywords Pediatric . Solid organ transplant . Malignancy . Cancer . Post-transplantation lymphoproliferative disorder
Introduction Modern immunosuppression has increased life expectancy among pediatric solid organ transplant recipients (SOTRs), increasing the burden of post-transplantation comorbidities including malignancies [1, 2]. As long-term cardiovascular outcomes improve, it is estimated that malignancy will become the leading cause of death post-transplantation [1, 3]. * Abhijat Kitchlu [email protected] 1
Division of Paediatric Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
2
Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
3
Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
4
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
5
ICES McMaster, Hamilton, Ontario, Canada
6
Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, 200 Elizabeth Street, 8 Eaton North, 8 N-842, Toronto, Ontario M5G 2C4, Canada
Pediatric SOTRs are a particularly susceptible group, with significantly higher cancer incidence and mortality than agematched non-transplant populations [4–8].
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