Moosa Mohammed R
From Department of Internal Medicine, University of Stellenbosch and Renal Transplant Unit, Tygerberg Academic Hospital, Cape Town, Western Cape, South Africa.
Medicine (Baltimore). 2005 Jan;84(1):12-22. doi: 10.1097/01.md.0000152372.30370.6f.
Malignancies are a well-recognized complication of renal transplantation. Although the problem is well studied in developed countries, less is known about it in developing countries. Although geographic and ethnic variations have been alluded to in several reports, to our knowledge the subject has not been investigated formally. From April 1976 through March 1999, 41 (7.6%) patients were diagnosed with cancer among a heterogeneous population of renal allograft recipients treated at our institution in Cape Town, South Africa. The incidence of malignancies was comparable in white and nonwhite patients. However, squamous cell cancer and basal cell cancer of the skin (in that order) were the most common cancers in white patients, in whom they occurred exclusively. On the other hand, Kaposi sarcoma was the most common cancer in nonwhite renal allograft recipients, in whom it accounted for almost 80% of all cancers. Review of the world literature suggests that posttransplant cancers are less common in developing countries; Kaposi sarcoma is the most common lesion, with few exceptions. Malignant lymphomas are also more common in developing countries. The impact of different immunosuppressive regimens is controversial. In general, cyclosporine is not associated with a significant increase in the incidence of cancer after renal transplantation, although the time to the first cancer may be reduced. In our experience, the pattern of posttransplant cancers in white and nonwhite patients living in the same geographic region epitomizes the world experience of the disease and suggests that genetic factors, rather than geography, are the more important determinants of cancer development after renal transplantation.
恶性肿瘤是肾移植公认的并发症。虽然在发达国家对这个问题已有充分研究，但在发展中国家对此了解较少。尽管几份报告中已提及地理和种族差异，但据我们所知，尚未对该主题进行正式调查。从1976年4月至1999年3月，在南非开普敦我们机构接受治疗的异种肾移植受者群体中，有41名（7.6%）患者被诊断患有癌症。白人和非白人患者的恶性肿瘤发病率相当。然而，皮肤鳞状细胞癌和基底细胞癌（按此顺序）是白人患者中最常见的癌症，且仅在白人患者中出现。另一方面，卡波西肉瘤是非白人肾移植受者中最常见的癌症，几乎占所有癌症的80%。对世界文献的回顾表明，移植后癌症在发展中国家较少见；卡波西肉瘤是最常见的病变，仅有少数例外。恶性淋巴瘤在发展中国家也更常见。不同免疫抑制方案的影响存在争议。一般来说，肾移植后使用环孢素虽可能缩短首次患癌时间，但与癌症发病率显著增加无关。根据我们的经验，生活在同一地理区域的白人和非白人患者移植后癌症的模式体现了全球该疾病的情况，表明遗传因素而非地理位置是肾移植后癌症发生的更重要决定因素。
