The purpose of this study was to determine the frequency and the outcome of de novo
malignancies in a cohort of renal transplant paediatric patients. The records of 493 kidney transplants, carried out in 454 paediatric recipients at the three paediatric transplant centres of the North Italy Transplant programme (
NITp, Italy) were reviewed. 10 cases of
malignancies (2.2%) comprising both PTLD (post-transplant
lymphoproliferative disorders) (6 cases, 1.3%) and non-PTLD
malignancies (4 cases, 0.88%) were reported. Non-PTLD included one urothelial
carcinoma and one Wilms' tumour of the recipient's left native kidney, one abdominal
dysgerminoma and one
optic nerve glioma of the left eye. The PTLD consisted of localised or disseminated Epstein-Barr virus (EBV)--associated B-lymphocyte monoclonal (5 cases) and polyclonal (1 case) proliferations. All patients suffering from PTLD had been EBV-negative at the time of
transplantation, but developed EBV primary
infection after
transplantation. All PTLD patient donors were EBV-positive. In addition, all but 1 patient received, before and/or after
transplantation, a range of immunosuppressive drugs in addition to the baseline prophylactic immunosuppressive regimen. Moreover, 3 patients suffered from syndromes associated with a
genetic predisposition to
cancer. Finally, the
malignancies reported here were associated with 20% graft failure and 20% mortality rates.