Wong Germaine, Chapman Jeremy R
NHMRC Centre for Clinical Research Excellence in Renal Medicine, Children's Hospital at Westmead, NSW 2145, Australia.
Transplant Rev (Orlando). 2008 Apr;22(2):141-9. doi: 10.1016/j.trre.2007.12.004.
For patients with end-stage kidney failure, kidney transplantation improves both their quality of life and overall life expectancy compared with dialysis, but it is not without adverse effects. Cancer is second to cardiovascular disease as one of the major causes of morbidity and mortality in renal transplant recipients. Prolonged use of modern immunosuppression, which leads to alteration of immune function and immune surveillance, is associated with increased cancer risk. There is now convincing evidence from observational studies and registry data to confirm a 3- to 5-fold increase in overall cancer incidence, with viral-related neoplasia incurring the greatest risk when compare with the general population. Despite the increased risk, little is known about the overall cancer prognosis, screening, treatment strategies, and effectiveness in this population. Cancers can recur, occur de novo, and be transmitted from donor organs posttransplantation. Uncertainties exist as to how modern immunosuppressive agents impact on cancer management and outcomes in these patients, with some agents such as calcineurin inhibitors and azathioprine, being more carcinogenic than others. The newer agents, proliferation signal/mammalian target of rapamycin inhibitors and mycophenolate mofitil, may have some antiproliferative and antitumor activities demonstrated in preclinical and clinical studies, but long-term well-powered trial data are needed to determine whether they are either protective or curative for cancers in renal transplant recipients. In this review, the incidence, etiology, prognosis, and potential approaches to cancer screening and management post-renal transplantation are discussed.
对于终末期肾衰竭患者，与透析相比，肾移植可改善其生活质量和总体预期寿命，但并非没有不良反应。癌症是肾移植受者发病和死亡的主要原因之一，仅次于心血管疾病。长期使用现代免疫抑制剂会导致免疫功能和免疫监视改变，从而增加患癌风险。目前，观察性研究和登记数据提供了令人信服的证据，证实总体癌症发病率增加了3至5倍，与普通人群相比，病毒相关肿瘤的风险最高。尽管风险增加，但对于该人群的总体癌症预后、筛查、治疗策略及有效性却知之甚少。癌症可在移植后复发、新发或从供体器官传播。目前尚不确定现代免疫抑制剂如何影响这些患者的癌症管理和治疗结果，一些药物如钙调神经磷酸酶抑制剂和硫唑嘌呤比其他药物更具致癌性。新型药物，如增殖信号/雷帕霉素哺乳动物靶点抑制剂和霉酚酸酯，在临床前和临床研究中可能具有一些抗增殖和抗肿瘤活性，但需要长期的有力试验数据来确定它们对肾移植受者的癌症是否具有保护或治疗作用。在这篇综述中，我们讨论了肾移植后癌症的发病率、病因、预后以及癌症筛查和管理的潜在方法。
