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De novo neoplasias in pediatric kidney transplant recipients: a multicenter analysisaTransplant Immunology and eTransplantation Surgery Units, S.Martino Hospital, Genoa; bImmunology and Transplant Laboratory, Department of Pediatrics, IRCCS Policlinico S. Matteo, Pavia; cDepartment of Pediatrics, Milan University, Milan; dDepartment of Pediatrics, Padua University, Padua; gTransplant Immunology and Blood Transfusion Center, IRCCS Maggiore Hospital, Milan; fDepartment of Pediatric Nephrology,G.Gaslini Institute, Genoa - ITALY.AIM In this study, the frequency and the outcome of de novo malignancies were evaluated in a cohort of pediatric kidney transplant patients. METHODS The records of 640 kidney transplants, carried out in 585 pediatric recipients at the three pediatric transplant centers of the North Italy Transplant program were reviewed. RESULTS Sixteen cases of malignancies (2.7%) comprising both PTLD (Post-Transplant Lymphoproliferative Disorders) (12 cases, 2%) and non-PTLD malignancies (4 cases, 0.7%) were reported. Non-PTLDs included one urothelial carcinoma and one Wilms tumor of the recipients left native kidney, one abdominal dysgerminoma and one optic nerve glioma of the left eye. The PTLD consisted of localized or disseminated Epstein-Barr virus (EBV)-associated B or T (n=1) cell lymphomas. All but one patients suffering from PTLD had been EBV-negative at the time of transplantation and developed EBV primary infection after the procedure. The vast majority of cancer patients received additional immunosuppression to the baseline regimen. A wide array of treatments, including reduction/discontinuation of immunosuppression, surgery, chemoradiotherapy, interferon-alpha and anti-CD20 monoclonal antibody, were employed. In addition to first line cancer therapy, 2 PTLD cases received autologous EBV-specific cytotoxic T cell line infusions to control the persistence of high EBV viral load. CONCLUSIONS The malignancies reported were associated with 12.5% graft failure and 31.2 % mortality rates. It is worth of notice that EBV-related PTLD still accounts for the majority of neoplasias observed after pediatric kidney transplantion. Moreover, PTLD number in the last few years showed a relative increase, likely reflecting the use of more aggressive immunosuppressive protocols. KEY WORDS: Kidney transplantation, Pediatric graft recipients, post-transplant de novo cancers, EBV infection, Post-transplant lymphoproliferative disorders, immunosuppressive therapy. For more information, contact anocera@smartino.ge.it Paper presented at the International Symposium on Predictive Oncology and Intervention Strategies; Paris, France; February 9 - 12, 2002; in the section on Viral Oncogenesis. |
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