Among pediatric transplant recipients, the effects of transplantation and immunosuppression on cancer risk may be unique from those observed in the adult transplant population. No prior study has comprehensively described cancer risk in this population and compared to general pediatric population cancer rates. The US transplant registry was linked to 16 cancer registries to identify cancer diagnoses among solid organ recipients <18 years of age at transplant. Standardized incidence ratios (SIRs) were estimated by dividing observed cancer counts after transplant by expected counts calculated based on general population rates within strata of age, sex, race, calendar year, and registry. We included 17,958 pediatric transplant recipients (44% of the US total). Among these recipients, 394 cancers were diagnosed, 71% of which were non-Hodgkin lymphomas (NHL) and 8% Hodgkin lymphoma (HL). Compared to the general population, cancer incidence was significantly increased overall (SIR=22, 95%CI=20-24) and for NHL, HL, leukemia, myeloma, and cancers of the anus, liver, soft tissue, breast, ovary, vulva, testis, bladder, kidney, and thyroid (Table). SIRs for lymphomas were highest for recipients <5 years old at transplant (NHL SIR=320, 95%CI=260-380; HL SIR=54, 95%CI=29-92). When evaluated by organ type, NHL risk was most elevated among intestine recipients (SIR=1300, 95%CI=530-2700) followed by heart/lung (SIR=320, 95%CI=250-390), liver (SIR=200, 95%CI=160-250) and kidney recipients (SIR=160, 95%CI=130-200). Pediatric transplant recipients have markedly higher risk for a number of cancers, but the majority of the cancer burden is attributable to NHL. Increased NHL risk was exceedingly high among the youngest recipients, who are likely to develop primary Epstein-Barr virus infection after transplantation, and among intestine recipients.

« Back to 2015 American Transplant Congress