Serrano Oscar K, Gannon Alexis, Olowofela Ayokunle S, Reddy Apoorva, Berglund Danielle, Matas Arthur J
Department of Surgery, Division of Transplantation, University of Minnesota, Minneapolis, Minnesota.
Pediatr Transplant. 2019 Nov;23(7):e13557. doi: 10.1111/petr.13557. Epub 2019 Aug 13.
A childhood malignancy can rarely progress to ESRD requiring a KT. To date, few reports describe long-term outcomes of pediatric KT recipients with a pretransplant malignancy. Between 1963 and 2015, 884 pediatric (age: 0-17 years old) recipients received 1055 KTs at our institution. KT outcomes were analyzed in children with a pretransplant malignancy. We identified 14 patients who had a pretransplant malignancy prior to KT; the majority were <10 years old at the time of KT. Ten (71%) patients received their grafts from living donors, the majority of which were related to the recipient. Wilms' tumor was the dominant type of pretransplant malignancy, seen in 50% of patients. The other pretransplant malignancy types were EBV-positive lymphoproliferative disorders, non-EBV-positive lymphoma, leukemia, neuroblastoma, soft-tissue sarcoma, and ovarian cancer. Ten of the 14 patients received chemotherapy as part of their pretransplant malignancy treatment. Graft survival at 1, 3, and 5 years was 93%, 83%, and 72%, respectively. Patient survival at 1, 5, and 10 years was 100%, 91%, and 83%, respectively. Six (40%) patients suffered AR following KT; half of them had their first episode of AR within 1 month of KT. Our single-center experience demonstrates that pediatric KT recipients with a previously treated pretransplant malignancy did not exhibit worse outcomes than other pediatric KT patients.
儿童恶性肿瘤极少会进展为需要肾移植（KT）的终末期肾病（ESRD）。迄今为止，鲜有报道描述肾移植前患有恶性肿瘤的小儿肾移植受者的长期预后情况。1963年至2015年期间，884名儿科（年龄0至17岁）受者在我们机构接受了1055次肾移植。对肾移植前患有恶性肿瘤的儿童的肾移植预后进行了分析。我们确定了14名在肾移植前患有恶性肿瘤的患者；大多数患者在肾移植时年龄小于10岁。10名（71%）患者接受了来自活体供者的移植物，其中大多数与受者有亲缘关系。肾母细胞瘤是肾移植前恶性肿瘤的主要类型，50%的患者患有该疾病。其他肾移植前恶性肿瘤类型包括EB病毒阳性淋巴增殖性疾病、非EB病毒阳性淋巴瘤、白血病、神经母细胞瘤、软组织肉瘤和卵巢癌。14名患者中有10名在肾移植前接受了化疗，作为其恶性肿瘤治疗的一部分。1年、3年和5年的移植物存活率分别为93%、83%和72%。1年、5年和10年的患者存活率分别为100%、91%和83%。6名（40%）患者在肾移植后发生急性排斥反应（AR）；其中一半在肾移植后1个月内首次发生AR。我们的单中心经验表明，先前接受过治疗的肾移植前患有恶性肿瘤的小儿肾移植受者的预后并不比其他小儿肾移植患者差。
