Moal M-C
Service de Néphrologie, CHU de Brest, Brest, France.
Nephrol Ther. 2008 Oct;4 Suppl 3:S214-7. doi: 10.1016/S1769-7255(08)74238-X.
The overall risk of cancer in the kidney transplant patient is three to five times higher than the risk in the general population, and the risk of cutaneous epitheliomas, the most frequent, is multiplied by 100. There are many causes of posttransplantation cancer involving modifications in the immunosurveillance of neoplastic cells, viral reactivation or an increase in viral infections, genetic or acquired risks, but also immunosuppressors. Azathioprine and anticalcineurins in particular are associated with an increase in cancer risk. This is why at-risk patients should be monitored closely before and after transplantation. During the pretransplantation period, the risk factors present should be eradicated and the patient screened for cancers. In the posttransplantation period, prevention is indispensable, with regular screening for cancer, sun protection, and induction treatment adapted to the risk present. In transplantation patients who have developed cancer, immunosuppression can, however, be preserved using proliferation signal inhibitors, which present useful anti-tumor activity at doses that are effective for immunosuppression. Effective treatment of the cancer can now be expected without systematically losing the graft after interrupting the transplantation treatment.
肾移植患者患癌的总体风险比普通人群高3至5倍,而最常见的皮肤上皮瘤风险则高出100倍。移植后癌症有多种病因,包括肿瘤细胞免疫监视的改变、病毒再激活或病毒感染增加、遗传或后天风险,还有免疫抑制剂。特别是硫唑嘌呤和抗钙调神经磷酸酶与癌症风险增加有关。这就是为什么高危患者在移植前后都应密切监测。在移植前期,应消除存在的风险因素并对患者进行癌症筛查。在移植后期,预防必不可少,要定期进行癌症筛查、防晒,并根据存在的风险进行诱导治疗。然而,对于已患癌症的移植患者,可以使用增殖信号抑制剂来维持免疫抑制,这些抑制剂在对免疫抑制有效的剂量下具有有用的抗肿瘤活性。现在有望在不中断移植治疗就系统性失去移植物的情况下有效治疗癌症。