Amital Anat, Shitrit David, Raviv Yael, Bendayan Daniele, Sahar Gideon, Bakal Ilana, Kramer Mordechai R
Pulmonary Institute, Rabin Medical Center, Belinson Campus, and Tel Aviv University, Tel Aviv, Israel.
Transplantation. 2006 Feb 27;81(4):547-51. doi: 10.1097/01.tp.0000195774.26382.34.
A substantial excess risk of certain malignancies has been demonstrated after organ transplantation. Immunosuppressive treatment to prevent allograft rejection is probably the main cause.
We reviewed retrospectively all medical records of the 121 patients that underwent lung and heart-lung transplantation from 1992 until December 2004. We compared our results to the International Society for Heart and Lung Transplantation (ISHLT) registry data and previous reports concerning lung transplantation.
102 of the 121 patients survived for 3 months to 12 years. Malignancies developed in 16 patients, as follows: lymphoproliferative disorder in 3, Kaposi's sarcoma in 3, other nonmelanoma skin cancers in 7, urinary bladder transitional cel carcinoma in 3, and colon cancer in 1. Patients with malignancy were older at transplantation than those without (mean +/- SD, 54.1+/-7.8 vs. 49.5+/-14.2 years; P=0.03). Fourteen had smoked in the past. Four died of bronchiolitis obliterans. In comparison with the ISHLT, we observed more skin cancer and transitional cell carcinoma (12.8% vs. 0.7% and 3.8% vs. 0.03%, respectively) and a similar frequency of posttransplant lymphoproliferative disease.
We conclude that malignancy is a common complication after lung transplantation. In Israel, which is sunny most of the year, skin cancers and transitional cell carcinoma of bladder are more common. Modification of the immunosuppression late posttransplantation may reduce the risk of cancer. Patients should also be counseled to avoid sun exposure and ensure adequate hydration.
器官移植后已证实某些恶性肿瘤存在显著的额外风险。预防移植器官排斥的免疫抑制治疗可能是主要原因。
我们回顾性分析了1992年至2004年12月期间接受肺移植和心肺移植的121例患者的所有病历。我们将我们的结果与国际心肺移植学会（ISHLT）登记数据以及先前关于肺移植的报告进行了比较。
121例患者中有102例存活了3个月至12年。16例患者发生了恶性肿瘤，情况如下：3例为淋巴增生性疾病，3例为卡波西肉瘤，7例为其他非黑色素瘤皮肤癌，3例为膀胱移行细胞癌，1例为结肠癌。发生恶性肿瘤的患者移植时年龄比未发生者大（平均±标准差，54.1±7.8岁对49.5±14.2岁；P = 0.03）。14例患者过去吸烟。4例死于闭塞性细支气管炎。与ISHLT相比，我们观察到更多的皮肤癌和移行细胞癌（分别为12.8%对0.7%和3.8%对0.03%）以及移植后淋巴增生性疾病的相似发生率。
我们得出结论，恶性肿瘤是肺移植后常见的并发症。在以色列，一年中大部分时间阳光充足，皮肤癌和膀胱移行细胞癌更为常见。移植后期调整免疫抑制可能会降低癌症风险。还应建议患者避免阳光照射并确保充足补水。
