Long-term follow-up for incident cirrhosis among pediatric cancer survivors with hepatitis C virus infection

Background: Pediatric cancer patients who received blood transfusions were potentially exposed to hepatitis C virus (HCV) prior to second-generation HCV screening of blood products in 1992. Limited evidence is available about long-term incident cirrhosis in this population. Objectives: We aimed to estimate the overall and sex-specific incidence of cirrhosis among HCV-seropositive survivors of pediatric cancer. Study design: We identified 113HCV-seropositive pediatric cancer patients treated at St. Jude Children's Research Hospital between 1962 and 1997, who survived >= 5 years post-diagnosis, and were followed through 2014. Our outcome was cirrhosis determined by liver biopsy or diagnostic imaging. We used a competing-risk framework to estimate the overall and sex-specific cumulative incidence and 95% confidence limits (CL) of cirrhosis at 10-year follow-up intervals. Results: The median duration of follow-up was 30 years (interquartile range = 28-36) post-cancer diagnosis. Cumulative incidence of cirrhosis increased at each 10-year interval from 0% after 10 years to 13% after 40 years (P-trend < 0.001). The median age at diagnosis of cirrhosis was 30 years (interquartile range = 24-38). We observed a linear trend in incidence for males (P-trend < 0.001), with a cumulative incidence of 18% (95% CL: 6.1%, 34%) after 40 years. The cumulative incidence for females was 6.5% (95% CL: 0.42%, 26%) after 40 years, but we did not observe a linear trend (P-trend = 0.99). Conclusion: Our results suggest that the incidence of cirrhosis is similar between HCV-seropositive pediatric cancer survivors and the general population given similar duration of follow-up, but survivors may be diagnosed with cirrhosis at an earlier age. (C) 2015 Elsevier B.V. All rights reserved.