The outcome of kidney transplantation in children with end stage renal disease secondary to renal tumor (Wilms tumor)

Abstract

【Purpose】The aim of this study is to evaluate whether children with end stage renal disease (ESRD) secondary to Wilms’ tumor could successfully received kidney transplantation (KT).【Methods】Retrospective study of 11 pediatric patients with Wilms’ tumor who have undergone KT between 1990 and 2013 was conducted.【Results】The mean age at diagnosis of Wilms’ tumor was 2.0±1.8 years with 2 boys and 9 girls. WT-1 gene analysis showed heterozygous germline mutations in exon 9 on 7 patients. Five children had unilateral tumor (stage Ⅰ～Ⅳ) and 6 children had bilateral tumor (stage Ⅴ). Histopathological findings of the tumors were favorable histology (FH) in all cases. Six patients with bilateral tumors received chemotherapy and radiotherapy following bilateral kidney-sparing surgery (n＝3) or bilateral nephrectomy (n＝3). Five patients with unilateral tumor underwent nephrectomy with chemotherapy. Additional chemotherapy was needed in 2 patients because of recurrence of the tumor. Eight patients were dialyzed prior to transplantation. The median age at dialysis was 2.8 year (range 1.5 to 13.5). Three patients underwent KT preemptively. The mean waiting time for KT after completion of chemotherapy for WT was 4.2±1.4 years. Graft survival at 5-and 10 year posttransplant was 100%, and 80%, respectively. Of 3 children with additional treatment for the recurrence of tumor before KT, 1 patient of the DDS group showed the re-recurrence/metastasis of the tumor 4.8 years after KT.【Conclusion】Based on the improved long-term survival rates for patients with Wilms’ tumor of FH, the excellent long-term patient and graft survival was observed even in the patients with high stage Wilms’ tumor.