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Treatments and outcomes for end-stage renal disease following Wilms tumor

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Abstract

Background

Little is known about treatment outcomes for children who have end-stage renal disease (ESRD) after treatment for Wilms tumor (WT).

Methods

Time-to-transplant, graft failure, and survival outcomes were examined for 173 children enrolled on the National Wilms Tumor Study who developed ESRD.

Results

Fifty-five patients whose ESRD resulted from progressive bilateral WT (PBWT) experienced high early mortality from WT that limited their opportunity for transplant (47% at 5 years) and survival (44% at 10 years) in comparison to population controls. The 118 patients whose ESRD was due to other causes (termed “chronic kidney disease”), many of whom had WT-associated congenital anomalies, had transplant (77% at 5 years) and survival (73% at 10 years) outcomes no worse than those for population controls. Graft failure following transplant was comparable for the two groups. Minority children had twice the median time to transplant as non-Hispanic whites and twice the mortality rates, also reflecting population trends.

Conclusions

In view of the continuing high mortality in patients with ESRD, and the dramatic improvement in outlook following kidney transplantation, re-evaluation of current guidelines for a 2-year delay in transplant following WT treatment may be warranted.

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Acknowledgments

This study was supported in part by grant CA054498 from the United States National Cancer Institute. We thank investigators of the Children’s Oncology Group and the health professionals who managed the care of children entered in the National Wilms Tumor Study.

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Authors and Affiliations

  1. Department of Biostatistics and Bioinformatics, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Yevgeny Grigoriev, Susan M. Peterson, Janice R. Takashima & Norman E. Breslow

  2. Department of Biostatistics, University of Washington, Mail Stop 357232, Seattle, WA, 98195-7232, USA

    Jane Lange & Norman E. Breslow

  3. Department of Urology, Phoenix Children’s Hospital, Phoenix, AZ, USA

    Michael L. Ritchey

  4. Departments of Surgery, Urology and Pediatric Surgery, Massachusetts General Hospital, Boston, MA, USA

    Dicken Ko

  5. Department of Hematology/Oncology, Children’s Hospital and Research Center Oakland, Oakland, CA, USA

    James H. Feusner

  6. Department of Surgery, Children’s Hospital, Boston, MA, USA

    Robert C. Shamberger

  7. Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Daniel M. Green

Authors
  1. Yevgeny Grigoriev
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  2. Jane Lange
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  3. Susan M. Peterson
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  4. Janice R. Takashima
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  5. Michael L. Ritchey
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  6. Dicken Ko
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  7. James H. Feusner
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  8. Robert C. Shamberger
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  9. Daniel M. Green
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  10. Norman E. Breslow
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Corresponding author

Correspondence to Norman E. Breslow.

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Grigoriev, Y., Lange, J., Peterson, S.M. et al. Treatments and outcomes for end-stage renal disease following Wilms tumor. Pediatr Nephrol 27, 1325–1333 (2012). https://doi.org/10.1007/s00467-012-2140-x

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  • DOI: https://doi.org/10.1007/s00467-012-2140-x

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