Pediatric Nephrology

, Volume 27, Issue 8, pp 1325–1333 | Cite as

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

  • Yevgeny Grigoriev
  • Jane Lange
  • Susan M. Peterson
  • Janice R. Takashima
  • Michael L. Ritchey
  • Dicken Ko
  • James H. Feusner
  • Robert C. Shamberger
  • Daniel M. Green
  • Norman E. Breslow
Original Article

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.

Keywords

Chronic kidney failure Transplantation Graft failure 

Notes

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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Copyright information

© IPNA 2012

Authors and Affiliations

  • Yevgeny Grigoriev
    • 1
  • Jane Lange
    • 2
  • Susan M. Peterson
    • 1
  • Janice R. Takashima
    • 1
  • Michael L. Ritchey
    • 3
  • Dicken Ko
    • 4
  • James H. Feusner
    • 5
  • Robert C. Shamberger
    • 6
  • Daniel M. Green
    • 7
  • Norman E. Breslow
    • 1
    • 2
  1. 1.Department of Biostatistics and BioinformaticsFred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.Department of BiostatisticsUniversity of WashingtonSeattleUSA
  3. 3.Department of UrologyPhoenix Children’s HospitalPhoenixUSA
  4. 4.Departments of Surgery, Urology and Pediatric SurgeryMassachusetts General HospitalBostonUSA
  5. 5.Department of Hematology/OncologyChildren’s Hospital and Research Center OaklandOaklandUSA
  6. 6.Department of SurgeryChildren’s HospitalBostonUSA
  7. 7.Department of Epidemiology and Cancer ControlSt. Jude Children’s Research HospitalMemphisUSA

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