Elevated Risk of Cancer Following Solid Organ Transplant in Childhood: A Population-based Cohort Study

Background Cancer risk is elevated among adult transplant recipients, but there is limited data regarding long-term cancer risk and mortality in pediatric recipients. Methods We conducted a population-based retrospective cohort study in Ontario, Canada. We included pediatric recipients of solid organ transplants at the Hospital for Sick Children, Toronto from 1991 to 2014, and compared rates of new cancers and cancer-specific mortality to nontransplanted Ontario children born in the same year. We constructed standard and time-dependent Cox proportional hazards models accounting for competing risk of death. Results A total of 951 recipients (kidney n=400, liver n=283, heart n=218, lung n=36, multiorgan/small bowel n=14) were compared to 5.3 million general population children. Mean (SD) age was 8.2 (6.4) years; 50% were male. Over a mean (SD) follow-up of 10.8 (7.1) years, cumulative incidence of cancer was 20% in recipients and 1.2% in the general population (incidence rate ratio 32.9; 95% CI 26.6-40.8). Risk was highest in the first year posttransplant (aHR 176; 95% CI 117-264), but remained elevated beyond 10 years (aHR 10.8; 95% CI 6.3-18.6). Lymphoproliferative disorders were predominant (77%); however, solid cancers (renal, sarcomas, genital, thyroid) were seen. Recipients of lung or multiorgan transplants were at highest risk. Cancer-specific mortality was also higher among recipients (HR 93.1; 95% CI 59.6-145.2). Conclusions Childhood transplant recipients have a 30-times greater cancer incidence versus the general population. Further investigation is needed to guide screening strategies in this at-risk population. *Corresponding Author Contact Information: Rulan S. Parekh, MD, MS., FRCPC, Nephrologist, Division of Nephrology, Associate Chief, Clinical Research, Scientist, Child Health Evaluative Sciences, Research Institute, Professor, Faculty of Medicine, Institute of Medical Sciences and Dalla Lana School of Public Health, University of Toronto, Peter Gilgan Centre for Research & Learning, The Hospital for Sick Children (SickKids), 686 Bay Street, Child Health Evaluative Sciences, 11th floor, Toronto, ON, Canada, M5G 0A4, Phone: 416-813-7654 ext. 328042, Fax: 416-813-5979. Email: rulan.parekh@sickkids.ca AUTHORSHIP A.K., S.D., S.J.K., P.C.N., and R.S.P participated in the study design. A.K., S.D., S.G., and P.C.N. participated in the data analysis. A.K., S.D., J.S.D., P.C.N., and R.S.P drafted the manuscript. All authors read and approved the final manuscript. DISCLOSURES The authors declare no conflicts of interest. FUNDING Dr. Rulan S. Parekh received funding from the Transplant & Regenerative Medicine Centre (TRMC) Catalyst Grant at The Hospital for Sick Children, Ashley's Angels Catwalk and the Canadian Institutes of Health Research (CIHR) for the completion of this study. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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