Service de Transplantation Rénale et Soins Intensifs, Hôpital Necker-Assistance Publique-Hôpitaux de Paris, France.
Transpl Int. 2012 May;25(5):545-54. doi: 10.1111/j.1432-2277.2012.01451.x. Epub 2012 Feb 21.
The aim of this study was to analyze the clinical and immunological features of the 56 still alive patients at our institution harboring a functional first renal transplant since more than 30 years. The mean post-transplant graft survival in all patients was 35.4 ± 3.1 years, the mean serum creatinine concentration was 128.7 ± 7 μmol/l, and the mean urinary protein concentration was 0.6 ± 0.5 g/l. Fifty-one percent of the patients had experienced cancer involving the skin (46.1%) and/or other tissues (28%). Hepatocarcinoma was diagnosed in 11% of the patients with chronic viral hepatitis B and/or C (48%). The 5-year patient survival rate (considered after the 30th transplantation anniversary) was 27% in patients presenting a tumor versus 87% in those tumor-free (P < 0.0001). The thymic output, the proportions of the memory and naïve T cell subsets, and the frequencies of EBV- and CMV-reactive, IFN-γ-producing T cells did not differ from those observed in more recently transplanted patients. These results suggest that the impact of chronic immunosuppression on some immune functions does not worsen over time and that the observed high prevalence of cancer in these patients may be related to the synergistic effects of decreased immunosurveillance and the time required for carcinogenesis.
本研究旨在分析本中心 56 例功能性首次肾移植后存活 30 年以上患者的临床和免疫学特征。所有患者的平均移植后移植物存活率为 35.4 ± 3.1 年，平均血清肌酐浓度为 128.7 ± 7 μmol/l，平均尿蛋白浓度为 0.6 ± 0.5 g/l。51%的患者经历过皮肤（46.1%）和/或其他组织（28%）的癌症。在患有慢性乙型和/或丙型肝炎病毒的 11%的患者中诊断出肝癌（48%）。在有肿瘤的患者中，5 年患者生存率（在第 30 次移植周年后考虑）为 27%，而无肿瘤的患者为 87%（P < 0.0001）。胸腺输出、记忆和幼稚 T 细胞亚群的比例以及 EBV 和 CMV 反应性、IFN-γ 产生 T 细胞的频率与最近移植的患者观察到的没有差异。这些结果表明，慢性免疫抑制对某些免疫功能的影响不会随时间恶化，并且这些患者中观察到的癌症高发率可能与免疫监视减少和致癌所需时间的协同作用有关。
