Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.
Nephrol Dial Transplant. 2012 Feb;27(2):833-9. doi: 10.1093/ndt/gfr277. Epub 2011 Jun 1.
Renal transplantation has been regarded as the treatment of choice for end-stage renal disease. Renal transplantation increases the risk of cancers due to long-term immunosuppression. The types of post-transplantation malignancies may vary among different geographic regions and ethnic populations. To date, large population-based studies of post-transplantation malignancies in Asian renal transplant recipients (RTRs) have rarely been reported.
To investigate the patterns of post-transplantation malignancies in Chinese RTRs, we performed a nationwide population-based cohort study between 1997 and 2008 based on data from the National Health Insurance Database in Taiwan. Patterns of cancer incidence in RTRs were compared with those of the general population using standardized incidence ratios (SIRs).
Among the 4716 RTRs (2475 males and 2241 females; mean age 44.1 ± 12.4 years) and 22 556 person-years of observation, 320 post-transplant cancers were diagnosed. The SIR of all cancers was 3.75 (95% confidence interval 3.36-4.18). Women had a higher risk than men for the development of malignancies (SIR 5.04 for women and SIR 2.88 for men). Renal, bladder and liver cancers were the most common cancers, with SIRs of 44.29, 42.89 and 5.07, respectively. When stratified by age, RTRs of young age at transplant (<20 years) had the highest risk of post-transplantation malignancies.
This study demonstrates different patterns of malignancies after renal transplantation in Chinese RTRs, with higher incidences of kidney and bladder cancers. Physicians should be more vigilant in examining RTRs for post-transplantation malignancies especially in younger patients.
肾移植已被视为终末期肾病的首选治疗方法。由于长期免疫抑制，肾移植会增加癌症风险。不同地理区域和种族人群的移植后恶性肿瘤类型可能有所不同。迄今为止，很少有关于亚洲肾移植受者（RTR）移植后恶性肿瘤的大型基于人群的研究报告。
为了研究中国 RTR 移植后恶性肿瘤的模式，我们根据台湾全民健康保险数据库的数据，在 1997 年至 2008 年期间进行了一项全国性基于人群的队列研究。使用标准化发病比（SIR）比较 RTR 癌症发病率与一般人群的模式。
在 4716 名 RTR（2475 名男性和 2241 名女性；平均年龄 44.1±12.4 岁）和 22556 人年的观察中，诊断出 320 例移植后癌症。所有癌症的 SIR 为 3.75（95%置信区间 3.36-4.18）。女性发生恶性肿瘤的风险高于男性（女性 SIR 为 5.04，男性 SIR 为 2.88）。肾、膀胱和肝癌是最常见的癌症，SIR 分别为 44.29、42.89 和 5.07。按年龄分层，年龄较小（<20 岁）的 RTR 移植后发生恶性肿瘤的风险最高。
本研究表明，中国 RTR 肾移植后恶性肿瘤的模式不同，肾和膀胱癌的发病率较高。医生应更加警惕检查 RTR 的移植后恶性肿瘤，特别是在年轻患者中。
