National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, 376 Victoria St, Sydney, NSW, 2010, Australia.
BMJ. 2010 Feb 11;340:c570. doi: 10.1136/bmj.c570.
To compare cancer incidence in kidney transplant recipients during periods of transplant function (and immunosuppression) and after transplant failure (when immunosuppression is ceased or reduced). Design, setting, and participants Nationwide, population based retrospective cohort study of 8173 Australian kidney transplant recipients registered on the Australia and New Zealand Dialysis and Transplant Registry who first received a transplant during 1982-2003. Incident cancers were ascertained using linkage with national cancer registry records.
Cancer-specific standardised incidence ratios for periods of transplant function and for dialysis after transplant failure. Incidence was compared between periods using multivariate incidence rate ratios adjusted for current age, sex, and duration of transplantation.
All cases of Kaposi's sarcoma occurred during transplant function. Standardised incidence ratios were significantly elevated during transplant function, but not during dialysis after transplant failure, for non-Hodgkin's lymphoma, lip cancer, and melanoma. For each of these cancers, incidence was significantly lower during dialysis after transplant failure in multivariate analysis (incidence rate ratios 0.20 (95% CI 0.06 to 0.65) for non-Hodgkin's lymphoma, 0.04 (0.01 to 0.31) for lip cancer, and 0.16 (0.04 to 0.64) for melanoma). In contrast, standardised incidence ratios during dialysis after transplant failure remained significantly elevated for leukaemia and lung cancer, and cancers related to end stage kidney disease (kidney, urinary tract, and thyroid cancers), with thyroid cancer incidence significantly higher during dialysis after transplant failure (incidence rate ratio 6.77 (2.64 to 17.39)). There was no significant difference in incidence by transplant function for other cancers.
The effect of immunosuppression on cancer risk is rapidly reversible for some, but not all, cancer types. Risk reversal was mainly observed for cancers with a confirmed infectious cause. Risk of other cancers, especially those related to end stage kidney disease, remained significantly increased after reduction of immunosuppression.
比较移植肾功能（及免疫抑制）期间和移植失败后（免疫抑制停止或减少时）肾移植受者的癌症发病率。设计、地点和参与者：这是一项在澳大利亚和新西兰透析和移植登记处登记的 8173 名澳大利亚肾移植受者中进行的全国性、基于人群的回顾性队列研究，这些受者于 1982 年至 2003 年间首次接受移植。通过与国家癌症登记处记录的链接确定癌症发病情况。
移植功能期间和移植失败后透析期间的癌症特异性标准化发病比。使用调整当前年龄、性别和移植持续时间的多变量发病率比值比较各时期的发病率。
卡波西肉瘤的所有病例均发生在移植功能期间。非霍奇金淋巴瘤、唇癌和黑色素瘤的标准化发病比在移植功能期间显著升高，但在移植失败后的透析期间并未升高。在多变量分析中，每种癌症在移植失败后的透析期间发病率均显著降低（非霍奇金淋巴瘤的发病率比值为 0.20（95%CI 0.06 至 0.65），唇癌为 0.04（0.01 至 0.31），黑色素瘤为 0.16（0.04 至 0.64））。相比之下，白血病和肺癌以及与终末期肾病相关的癌症（肾、泌尿道和甲状腺癌）的标准化发病比在移植失败后的透析期间仍显著升高，且甲状腺癌的发病率在移植失败后的透析期间显著升高（发病率比值为 6.77（2.64 至 17.39））。对于其他癌症，移植功能期间的发病率无显著差异。
免疫抑制对某些癌症（而非所有癌症）的风险有快速的逆转作用。风险逆转主要见于已证实具有传染性病因的癌症。免疫抑制减少后，其他癌症（特别是与终末期肾病相关的癌症）的风险仍然显著增加。
