De novo cancers in paediatric renal transplant recipients: a multicentre analysis within the North Italy Transplant programme (NITp), Italy

The purpose of this study was to determine the frequency and the outcome of de novo malignancies in a cohort of renal transplant paediatric patients. The records of 493 kidney transplants, carried out in 454 paediatric recipi ents st the three paediatric transplant centres of the North Italy Transpla nt programme (NITp. Italy) were reviewed. 10 cases of malignancies (2.2%) c omprising both PTLD (post-transplant lymphoproliferative disorders) (6 case s, 1.3%) and non-PTLD malignancies (4 cases, 0.88%) were reported. Non-PTLD included one urothelial carcinoma and one Wilms' tumour of the recipient's left native kidney, one abdominal dysgerminoma and one optic nerve glioma of the left eye. The PTLD consisted of localised or disseminated Epstein-Ba rr virus (EBV)-associated B-lymphocyte monoclonal (5 cases) and polyclonal (1 case) proliferations. All patients suffering from PTLD had been EBV-nega tive at the time of transplantion. but developed EBV primary infection afte r transplantion. All PTLD patient donors were EBV-positive. In addition, al l but 1 patient received, before and/or after transplantation, a range of i mmunosuppressive drugs in addition to the baseline prophylactic immunosuppr essive regimen. Moreover, 3 patients suffered from syndromes associated wit h a genetic predisposition to cancer. Finally, the malignancies reported he re were associated with 20% graft failure and 20% mortality rates. (C) 2000 Published by Elsevier Science Ltd. Ail rights reserved.