Abou Ayache R, Thierry A, Bridoux F, Bauwens M, Belmouaz M, Desport E, Touchard G
Department of Nephrology, Centre Hospitalier Universitaire La Milétrie, 2 Rue de la Milétrie, 86021 Poitiers, France.
Transplant Proc. 2007 Oct;39(8):2592-4. doi: 10.1016/j.transproceed.2007.08.016.
The incidence of skin cancer after organ transplantation is mainly related to type, level, and duration of immunosuppression. The immunosuppressive minimization strategy reduces skin malignancies, but no data are available concerning long-term calcineurin inhibitor (CNI) monotherapy compared with bi- or tritherapy. We studied the benefits of long-term CNI monotherapy (>6 years of exposure) with regard to the incidence of squamous cell carcinomas (SCC) and basal cell carcinomas (BCC) compared with bi- or tritherapy, among first renal allograft adult recipients who were more than 6 years posttransplantation. Among 294 renal transplantations performed between 1986 and 1999, 80 patients received CNI monotherapy (MT) and 86 patients bi- or tritherapy (BTT) with a follow-up of more than 6 years. MT patients were older, had longer follow-up, and fewer biopsy-proven acute rejection episodes. The incidence of SCC was 15.9 SCC/1000 patients/year for MT vs 26.2 for BTT (P = .07). The incidence was significantly lower for patients older than 40 years (22.4 vs 56, respectively; P < .01). The incidence of BCC was 28.3 BCC/1000 patients/year for MT and 10.1 for BTT (P = .05), which failed to show a significant difference in patients older than 40 years (39.7 vs 25, respectively; P = .09). The ratio of SCC/BCC in MT was maintained around 1/2 over time, while it exceeded 2/1 in BTT after 12 years posttransplantation. Patient survival was comparable between the 2 groups. A higher graft survival rate was observed in the MT group. CNI monotherapy should be considered to be a beneficial, safe immunosuppressive minimization strategy for SCC in selected recipients.
器官移植后皮肤癌的发病率主要与免疫抑制的类型、程度和持续时间有关。免疫抑制最小化策略可降低皮肤恶性肿瘤的发生率，但与双联或三联疗法相比，关于长期使用钙调神经磷酸酶抑制剂（CNI）单一疗法的数据尚不可得。我们研究了在移植后超过6年的成年首例肾移植受者中，与双联或三联疗法相比，长期CNI单一疗法（暴露超过6年）对鳞状细胞癌（SCC）和基底细胞癌（BCC）发病率的影响。在1986年至1999年间进行的294例肾移植中，80例患者接受了CNI单一疗法（MT），86例患者接受了双联或三联疗法（BTT），随访时间超过6年。MT组患者年龄更大，随访时间更长，活检证实的急性排斥反应发作次数更少。MT组SCC的发病率为每年15.9例SCC/1000例患者，BTT组为26.2例（P = 0.07）。40岁以上患者的发病率显著更低（分别为22.4例和56例；P < 0.01）。MT组BCC的发病率为每年28.3例BCC/1000例患者，BTT组为10.1例（P = 0.05），在40岁以上患者中未显示出显著差异（分别为39.7例和25例；P = 0.09）。MT组中SCC/BCC的比例随时间维持在1/2左右，而移植后12年BTT组该比例超过2/1。两组患者的生存率相当。MT组观察到更高的移植物存活率。对于特定受者的SCC，应考虑CNI单一疗法是一种有益、安全的免疫抑制最小化策略。
