Transplanting One Problem for Another

* Abbreviation: EBV — : Epstein-Barr virus Major advances have been made in the field of pediatric solid organ transplant, with significant improvements in long-term survival for children requiring this life-saving intervention.1 Developments in supportive care, organ allocation, HLA antigen matching, and immunosuppressive regimens have all contributed to this success.2–4 With more patients surviving longer, however, there has also been an increase in the long-term complications of transplantation.5 In addition to other organ toxicities, allograft loss, and impaired health-related quality of life,6,7 a dramatic increase in cancer incidence has been seen in organ transplant recipients.8,9 The overall increased incidence of malignancy in patients who have received solid organ transplants has been reported to range from a two- to six-fold increase above the general population,8,10 depending on the cohort and type of transplant. The cumulative incidence has been reported to be as high as 55% … Address correspondence to Daniel S. Wechsler, MD, PhD, Pediatric Hematology-Oncology, Duke University Medical Center, 397 Hanes House, DUMC Box 102382, Durham, NC 27710. E-mail: dan.wechsler{at}duke.edu