Solid Organ Transplants and the Subsequent Risk of Malignancy: A Concern Worth Knowing About :

When one begins to think of contributions that have made a difference in improving health outcomes for children with chronic illness, solid organ transplantation certainly needs to be on that list. While many of us have cared for patients before, during, or after they receive their transplant, we may not have considered whether secondary health outcomes might be associated with long-term survival—at least until Yanek et al. (10.1542/peds.2016-3893) looked at whether or not post-transplant patients have an increased risk of cancer.  The authors looked at 16 different cancer registries to see if cancer appeared in patients who were less than 18 years old at transplant and compared the rate of developing cancer in post-transplant patients to those who are in the general population (and who have not received a solid organ transplant).  The results show a marked increase in the incidence of cancers occurring in children who have received a transplant—especially in the first year after the operation.  As to what cancers are occurring and at what frequency, as well as what might be some risk factors associated with developing a malignancy post-transplant—we’ll leave you to discover that by reading this concerning study.  If you are following a child for primary care following their having had a solid organ transplant or are a specialist doing similarly, this article may make you even more vigilant to watch for signs and symptoms of cancer occurring even during childhood.  Does that mean one should not consider a solid organ transplant for a child who needs that operation?  Of course not—just that we need to monitor for the risk factors identified in this study (such as developing primary EBV infection after transplant) so that appropriate diagnostic testing and treatment can ensue should a cancer be detected. To help put this study in context, oncologists Dr. Alexandra Borst and Daniel Wechsler from Duke (10.1542/peds.2017-0542) have written an elucidating commentary that should accompany reading of this important study.