Clinical outcomes of pediatric kidney replacement therapy after childhood cancer - ESPN/ERA Registry study.

Cancer and its treatment may lead to kidney injury and need for kidney replacement therapy (KRT). We identified 287 pediatric KRT patients with a malignancy history from the ESPN/ERA Registry. Of these, 197 had cancer as a primary cause of KRT (group 1) and 90 had a malignancy diagnosis before KRT (group 2). Two matched controls without malignancy were randomly selected for each patient. Data were complemented with a questionnaire. Median time to kidney transplantation (KT) from KRT initiation was 2.4 (IQR: 1.5-4.7), 1.5 (IQR: 0.4-3.3), 3.6 (IQR: 1.3-Q3 not reached), and 1.1 (IQR: 0.3-3.6) years for group 1, their controls, group 2 and their controls, respectively. Overall 10-year mortality on KRT was higher among cancer patients vs. controls in group 1: 16% vs. 9% (aHR 2.02, 95% CI: 1.21-3.37) and in group 2: 23% vs. 14% (aHR 2.32, 95% CI: 1.11-4.85). In contrast, 10-year patient survival after first KT was comparable to controls (93% vs. 96%; 100% vs. 94%, in groups 1 and 2, respectively). In summary, childhood cancer survivors' KT was delayed, their overall mortality on KRT was increased, but once transplanted, their long-term outcome was similar to other KT recipients.