Fernández A, Marcén R, Pascual J, Galeano C, Ocaña J, Arellano E M, Alfaro C, Villafruela J J, Burgos F J, Ortuño J
Department of Nephrology, Hospital Ramón y Cajal, Madrid, Spain.
Transplant Proc. 2006 Oct;38(8):2453-5. doi: 10.1016/j.transproceed.2006.08.016.
Cancer has been reported to be more common among kidney transplant recipients than waiting-list patients or the general population. Use of anticalcineurin agents and azathioprine are relevant risk factors. Nine renal allograft recipients (seven men and two women) of mean age 67.6 (55-77) years and mean time after transplantation of 30.7 (58-216) months were switched to everolimus-based immunosuppression because of the presence of biopsy-proven malignancies (eight patients) or neurological tacrolimus toxicity (one patient). One patient with posttransplant lymphoproliferative disease also received chemotherapy with a good evolution at 6 months. He showed an initial increase in the protein to creatinine ratio (peak 3.3 mg/mg at 3 months) that was controlled by increasing the enalapril dose. One patient with skin cancer and severe atheromatosis (baseline SCr 2.5 mg/dL, creatinine clearance 17 mL/min, and protein to creatinine ratio 3.2 mg/mg), had cyclosporine and everolimus overlapped for 25 days, showing a continued poor evolution requiring dialysis initiation at 3 months after switch. The other six patients with recurrent skin cancers had good cancer evolution, with no new skin tumors and regression of skin lesions in three, including not biopsied actinic keratosis. Sudden switching from calcineurin inhibitors to everolimus is safe and may be used in long-term transplant recipients with malignancies. In patients with advanced chronic nephropathy this approach appeared to be less beneficial.
据报道，癌症在肾移植受者中比等待名单上的患者或普通人群更为常见。使用抗钙调神经磷酸酶药物和硫唑嘌呤是相关风险因素。9例肾移植受者（7例男性和2例女性），平均年龄67.6（55 - 77）岁，移植后平均时间30.7（58 - 216）个月，由于存在活检证实的恶性肿瘤（8例患者）或神经毒性他克莫司（1例患者），转而采用依维莫司为基础的免疫抑制治疗。1例移植后淋巴增殖性疾病患者也接受了化疗，6个月时病情进展良好。他最初的蛋白肌酐比值升高（3个月时峰值为3.3 mg/mg），通过增加依那普利剂量得到控制。1例患有皮肤癌和严重动脉粥样硬化的患者（基线血清肌酐2.5 mg/dL，肌酐清除率17 mL/min，蛋白肌酐比值3.2 mg/mg），环孢素和依维莫司重叠使用了25天，病情持续恶化，转换治疗3个月后需要开始透析。其他6例复发性皮肤癌患者癌症病情进展良好，没有新的皮肤肿瘤，3例皮肤病变消退，包括未活检的光化性角化病。从钙调神经磷酸酶抑制剂突然转换为依维莫司是安全的，可用于患有恶性肿瘤的长期移植受者。在晚期慢性肾病患者中，这种方法似乎益处较少。
