title: Incidence and Predictors of Cancer Following Kidney Transplantation in Childhood.
abstract: Cancer risk is increased substantially in adult kidney transplant recipients, but the long-term risk of cancer in childhood recipients is unclear. Using the Australian and New Zealand Dialysis and Transplant Registry, the authors compared overall and site-specific incidences of cancer after transplantation in childhood recipients with population-based data by using standardized incidence ratios (SIRs). Among 1734 childhood recipients (median age 14 years, 57% male, 85% white), 289 (16.7%) developed cancer (196 nonmelanoma skin cancers, 143 nonskin cancers) over a median follow-up of 13.4 years. The 25-year cumulative incidences of any cancer were 27% (95% confidence intervals 24-30%), 20% (17-23%) for nonmelanoma skin cancer, and 14% (12-17%) for nonskin cancer (including melanoma). The SIR for nonskin cancer was 8.23 (95% CI 6.92-9.73), with the highest risk for posttransplant lymphoproliferative disease (SIR 45.80, 95% CI 32.71-62.44) and cervical cancer (29.4, 95% CI 17.5-46.5). Increasing age at transplantation (adjusted hazard ratio [aHR] per year 1.10, 95% CI 1.06-1.14), white race (aHR 3.36, 95% CI 1.61-6.79), and having a functioning transplant (aHR 2.27, 95% CI 1.47-3.71) were risk factors for cancer. Cancer risk, particularly for virus-related cancers, is increased substantially after kidney transplantation during childhood.
authors.affiliation: Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia.|Centre for Kidney Research, Kids Research Institute at The Children's Hospital at Westmead, Westmead, NSW, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Francis
authors.affiliation: Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.|Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Australia.|Translational Research Institute, Brisbane, Australia.
authors.forename: D W
authors.initials: DW
authors.lastname: Johnson
authors.affiliation: Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia.|Centre for Kidney Research, Kids Research Institute at The Children's Hospital at Westmead, Westmead, NSW, Australia.
authors.forename: J C
authors.initials: JC
authors.lastname: Craig
authors.affiliation: Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia.|Centre for Kidney Research, Kids Research Institute at The Children's Hospital at Westmead, Westmead, NSW, Australia.|Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia.|Australian and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007680:Kidney Neoplasms; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology*; D009520:New Zealand / Q000453:epidemiology; D012042:Registries; D055815:Young Adult
keywords: cancer/malignancy/neoplasia: registry/incidence; cancer/malignancy/neoplasia: risk factors; clinical research/practice; kidney transplantation/nephrology; pediatrics