Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Transplantation. 2013 Aug 15;96(3):297-305. doi: 10.1097/TP.0b013e31829854b7.
It is unclear to what extent cancer history affects posttransplantation mortality in solid organ transplant recipients.
We identified a Swedish population-based cohort of solid organ transplant recipients in the National Patient Register 1970 to 2008 and linked it to the Cancer and Cause-of-Death Register. Overall and cause-specific mortality was estimated using Cox regression.
Of 10,448 eligible recipients, 416 (4%) had a prior malignancy unrelated to the indication for transplantation diagnosed 2 months or more before surgery (median, 5.7 years). Mortality among cancer history recipients was 30% increased after transplantation, compared with other recipients (adjusted hazard ratio [HR], 1.3; 95% confidence interval [CI], 1.1-1.5; P<0.001), driven by cancer-specific death with no increase in cardiovascular, infectious, or other noncancer mortality. An increased rate of death due to cancer history was primarily observed among nonkidney recipients (adjusted HR(nonkidney), 1.8; 95% CI, 1.3-2.5; HR(kidney), 1.2; 95% CI, 1.0-1.4). Rates were greatest for patients with waiting times of 5 years or less but persisted with waiting times more than 10 years among kidney and nonkidney recipients with prior aggressive cancer types (gastrointestinal, breast, kidney/urothelial, and hematologic malignancies).
We conclude that organ transplant recipients with cancer history are at a moderately increased rate of death after transplantation, driven primarily by death due to cancer recurrence.
癌症病史对实体器官移植受者移植后死亡率的影响程度尚不清楚。
我们在国家患者登记处 1970 年至 2008 年确定了一个瑞典基于人群的实体器官移植受者队列，并将其与癌症和死因登记处相关联。使用 Cox 回归估计总体和特定原因死亡率。
在 10448 名合格的受者中，有 416 名（4%）在手术前 2 个月或更长时间内患有与移植指征无关的先前恶性肿瘤（中位数为 5.7 年）。与其他受者相比，癌症病史受者移植后死亡率增加了 30%（调整后的危险比[HR]，1.3；95%置信区间[CI]，1.1-1.5；P<0.001），这主要归因于癌症特异性死亡，而心血管、感染或其他非癌症死亡率没有增加。在非肾脏受者中，由于癌症病史导致的死亡率增加更为明显（调整后的非肾脏 HR，1.8；95%CI，1.3-2.5；肾脏 HR，1.2；95%CI，1.0-1.4）。在等待时间为 5 年或更短的患者中，这一比率最高，但在等待时间超过 10 年的非肾脏和肾脏受者中，患有侵袭性癌症类型（胃肠道、乳腺、肾脏/尿路上皮和血液恶性肿瘤）的患者，这种比率仍然存在。
我们得出结论，有癌症病史的器官移植受者在移植后死亡的风险略高，主要原因是癌症复发导致的死亡。
