Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
Pediatr Transplant. 2024 Feb;28(1):e14697. doi: 10.1111/petr.14697.
In adults, pretransplant malignancy (PTM) negatively impacts patient survival due to immunosuppression regimens influencing post-transplantation tumor growth. Few reports investigate the outcomes of pediatric kidney transplantation with PTM. We compare transplant outcomes for pediatric patients with PTM to matched controls, including cancer types extending beyond Wilms tumor.
The United Network of Organ Sharing Database was queried to identify pediatric transplant recipients with histories of PTM. All PTM patients were matched to non-PTM patients, at a 1:1 ratio, with 0.001 match tolerance. Matching variables included transplant year, recipient age, recipient gender, recipient race, donor type, and prior transplant. Death-censored graft and patient survival were analyzed. All statistics were reported with 95% confidence intervals (CI).
After propensity matching, 285 PTM and 285 non-PTM patients were identified, with transplant dates from 1990 to 2020. Median Kidney Donor Profile Index values were comparable between cohorts, 17% and 12%, respectively (p = .065). Kaplan-Meier analysis revealed that PTM patients did not have a significantly different rate of death-censored graft failure, compared to the non-PTM group [HR 0.76; 95% CI (0.54-1.1)]. There was also no difference in the overall survival between the two groups of patients [HR 1.1; 95% CI (0.66-2.0)].
A history of pediatric malignancy has minimal independent effect on their post-transplant survival. Additionally, pediatric patients with PTM demonstrated equivalent rates of graft survival. Thus, in contrast to adults, renal failure in children with history of pediatric malignancies should not be considered a complicating factor for renal transplantation.
在成人中，由于免疫抑制方案会影响移植后肿瘤的生长，因此移植前恶性肿瘤（PTM）会对患者的生存产生负面影响。很少有报告研究患有 PTM 的儿科患者的肾移植结局。我们将患有 PTM 的儿科患者的移植结果与匹配对照进行比较，包括超出 Wilms 瘤的癌症类型。
美国器官共享网络数据库被查询以确定有 PTM 病史的儿科移植受者。所有 PTM 患者均与非 PTM 患者以 1:1 的比例匹配，匹配容差为 0.001。匹配变量包括移植年份、受者年龄、受者性别、受者种族、供者类型和先前的移植。分析死亡censored 移植物和患者的存活率。所有统计数据均以 95%置信区间（CI）报告。
经过倾向匹配，确定了 285 例 PTM 和 285 例非 PTM 患者，其移植日期为 1990 年至 2020 年。两组患者的中位数肾供体特征指数值相似，分别为 17%和 12%（p=0.065）。Kaplan-Meier 分析显示，与非 PTM 组相比，PTM 患者的死亡 censored 移植物失败率没有显著差异[HR 0.76；95%CI（0.54-1.1）]。两组患者的总生存率也没有差异[HR 1.1；95%CI（0.66-2.0）]。
儿科恶性肿瘤史对其移植后生存的独立影响较小。此外，患有 PTM 的儿科患者的移植物存活率相当。因此，与成人不同，患有儿科恶性肿瘤的儿童肾衰竭不应被视为肾移植的并发症。
