Outcomes after solid organ transplantation in survivors of childhood, adolescent, and young adult cancer: a population-based study.
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BACKGROUND: Cancer treatment can lead to organ toxicity requiring solid organ transplant. Transplant teams must evaluate the appropriateness of solid organ transplant in survivors of childhood or adolescent and young adult cancer. METHODS: Children treated at a provincial (Ontario, Canada) pediatric center for any cancer between 1986 and 2021 and adolescent and young adult (aged 15-21 years) treated in an adult center for 5 common cancer types between 1992 and 2012 were identified using population-based databases. Outcomes were determined by linkage to administrative databases. Transplanted cancer survivors were matched 1:2 to solid organ transplant recipients without a prior cancer. Post-solid organ transplant overall survival, subsequent cancers, severe cardiovascular disease, and graft loss or death were compared between groups. RESULTS: Among 16 533 cancer survivors, 52 received a solid organ transplant: 13 liver, 18 kidney, 11 lung, and 10 heart. Median age at solid organ transplant was 18 years (interquartile range [IQR] = 14-27 years). Transplanted cancer survivors experienced lower 10-year post-solid organ transplant overall survival than transplanted individuals with a history of cancer (67.7 vs 86.0%; P = .003). Ten-year cumulative incidence of developing another de novo malignancy was 8.6%, similar to the incidence of first cancers among individuals without a prior cancer history (12.9%; hazard ratio [HR] = 1.05, P = .91). Ten-year cumulative incidence of primary cancer recurrence was 10.5%. Transplanted cancer survivors (excluding heart transplants) were at risk for graft loss or death (HR = 2.00, 95% confidence interval [CI] = 1.01 to 3.94) but not severe cardiovascular disease (HR = 1.10, 95% CI = 0.50 to 2.41). CONCLUSION: Survivors treated with solid organ transplant had inferior survival than solid organ transplant recipients without a cancer history, but most achieved long-term cancer-free survival. These data can inform decisions around the suitability of cancer survivors for solid organ transplant.