A retrospective analysis from the Childhood Cancer Survivor Study reported in The Lancet Oncology by Dietz et al found that the need for solid organ transplantation was infrequent in aging survivors of childhood cancer, with greater organ-specific risk being associated with particular therapeutic exposures.
Study Details
The study involved data from 13,318 eligible survivors who survived for 5 years or more after cancer diagnosed at age younger than 21 years between January 1970 and December 1986. Eligible patients were those who had been diagnosed with leukemia, lymphoma, malignant central nervous system tumors, neuroblastoma, Wilms’ tumors, and bone and soft-tissue sarcoma. The data cutoff was the end of 2013.
Key Findings
Of 13,318 survivors, 100 had 103 solid organ transplantations (50 kidney, 37 heart, 9 liver, and 7 lung) and 67 were on a transplant waiting list (21 kidney, 25 heart, 15 liver, and 6 lung).
At 35 years after cancer diagnosis, the cumulative incidence of transplantation or being on a waiting list was 0.54% for kidney transplantation, 0.49% for heart, 0.19% for liver, and 0.10% for lung.
Statistically significant risk factors for transplantation or being on a waiting list included:
- Kidney: Unilateral nephrectomy (hazard ratio [HR] = 4.2, 95% confidence interval [CI] = 2.3–7.7); any ifosfamide (HR = 24.9, 95% CI = 7.4–83.5); total body irradiation (HR = 6.9, 95% CI = 2.3–21.1); and mean kidney radiation > 15-20 Gray (Gy) (HR = 3.6, 95% CI = 1.5–8.5) and > 20 Gy (HR = 4.6, 95% CI = 1.1–19.6)
- Heart: Anthracycline use (dose-dependent, P < .0001; HRs ranging from 8.4–94.2 with cumulative doses of > 0–150 to > 450 mg/m2); and mean heart radiation > 20 Gy (dose-dependent, P < .0001; HRs of 6.1 and 19.7 for > 20–30 Gy and > 30 Gy)
- Liver: Any dactinomycin (HR = 3.8, 95% CI = 1.3–11.3); and any methotrexate (HR = 3.3, 95% CI = 1.0–10.2)
- Lung: Any carmustine (HR = 12.3, 95% CI = 3.1–48.9); and mean lung radiation > 10 Gy (HR = 15.6, 95% CI = 2.6–92.7).
Five-year overall survival after solid organ transplantation was 93.5% for kidney transplant, 80.6% for heart, 27.8% for liver, and 34.3% for lung.
The investigators concluded, “Solid organ transplantation is uncommon in aging childhood cancer survivors. Organ-specific exposures were associated with increased solid organ transplantation incidence. Survival outcomes showed that solid organ transplantation should be considered for 5-year childhood cancer survivors with severe end-organ failure.”
Amanda M. Termuhlen, MD, of the Department of Pediatrics, University of Minnesota Medical School, Minneapolis, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by the National Institutes of Health, American Lebanese Syrian Associated Charities, and U.S. Health Resources and Services Administration. For full disclosures of the study authors, visit thelancet.com.
