Mynarek Martin, Hussein Kais, Kreipe Hans H, Maecker-Kolhoff Britta
Department of Pediatric Haematology and Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Pediatr Nephrol. 2014 Sep;29(9):1517-28. doi: 10.1007/s00467-013-2622-5. Epub 2013 Sep 24.
Post-transplant lymphoproliferative disease (PTLD) is the most frequent malignant complication of transplantation in childhood. Even with modern post-transplant immunosuppressive strategies, 1-2% of all kidney transplant recipients will develop PTLD within the first 5 years after transplantation, and the risk remains high even thereafter as long as immunosuppression is required. In addition to PTLD, adult kidney transplant recipients have an increased incidence of other immunosuppression-related malignancies, such as non-melanoma skin cancer or Kaposi's sarcoma. It is foreseeable that pediatric transplant recipients will face similar complications during their adult life. Not only immunosuppression but also other risk factors have been identified for some of these malignancies. Strategies addressing these risk factors during childhood may contribute to life-long cancer prevention. Furthermore, early recognition and regular screening may facilitate early diagnosis and treatment, thereby reducing transplant-related morbidity. In this review we focus on malignant complications after renal transplantation and discuss known risk factors. We also review current screening strategies for malignancies during post-transplant follow-up.
移植后淋巴细胞增生性疾病（PTLD）是儿童移植中最常见的恶性并发症。即使采用现代的移植后免疫抑制策略，所有肾移植受者中仍有1%-2%会在移植后的前5年内发生PTLD，并且只要需要免疫抑制，此后的风险仍然很高。除了PTLD，成年肾移植受者患其他免疫抑制相关恶性肿瘤的发生率也有所增加，如非黑色素瘤皮肤癌或卡波西肉瘤。可以预见，儿科移植受者在成年后也将面临类似的并发症。对于其中一些恶性肿瘤，不仅发现了免疫抑制因素，还发现了其他风险因素。在儿童时期针对这些风险因素采取策略可能有助于终身癌症预防。此外，早期识别和定期筛查可能有助于早期诊断和治疗，从而降低移植相关的发病率。在本综述中，我们重点关注肾移植后的恶性并发症，并讨论已知的风险因素。我们还回顾了移植后随访期间恶性肿瘤的当前筛查策略。
