Cheung Chi Yuen, Lam Man Fai, Chow Kai Ming, Lee William, Cheng Yuk Lun, Yuen Sze Kit, Wong Ping Nam, Mo Ka Leung, Leung Kay Tai, Wong Sze Ho, Ho Yiu Wing, Chau Ka Foon
Renal Unit, Queen Elizabeth Hospital , Hong Kong .
Ren Fail. 2014 Jul;36(6):865-9. doi: 10.3109/0886022X.2014.899879. Epub 2014 Mar 24.
Kidney transplant recipients have increased risk of cancers when compared with the general population. Hepatocellular carcinoma (HCC) is extremely important in Asia where hepatitis B virus (HBV) infection is endemic. The aim is to study the epidemiological and clinical aspects of all de novo HCC in our kidney transplant recipients. Moreover, various preventive strategies which may help to optimize the outcome will also be discussed. A retrospective review of all patients who developed HCC after kidney transplantation between May 1972 and December 2011 in Hong Kong, based on the data from Hong Kong Renal Registry. After a follow-up period of 40,246 person-years, 20 patients (males 15: females 5) developed HCC. The annual incidence was 49.7/100,000 persons per year. Among them, 16 were HBV carriers, 2 were hepatitis C (HCV) carriers and 2 had HBV and HCV co-infection. Presence of HBV infection was associated with 78-fold higher risk for HCC development. Majority (85%) were asymptomatic when HCC was diagnosed by ultrasound or alpha-fetoprotein surveillance. All patients diagnosed by surveillance received active treatment while 2/3 of symptomatic patients could only receive symptomatic care and died rapidly. In conclusion, HBV infection is the major etiological factor for HCC development in kidney transplant recipients in HBV endemic areas. Regular HCC surveillance appeared to be able to detect early stage cancers which are amenable to treatment and offer the best hope of cure.
与普通人群相比，肾移植受者患癌症的风险增加。肝细胞癌（HCC）在乙型肝炎病毒（HBV）感染流行的亚洲地区极为重要。目的是研究我们肾移植受者中所有新发HCC的流行病学和临床情况。此外，还将讨论有助于优化治疗结果的各种预防策略。基于香港肾脏登记处的数据，对1972年5月至2011年12月在香港肾移植后发生HCC的所有患者进行回顾性研究。经过40246人年的随访期，20例患者（男性15例：女性5例）发生了HCC。年发病率为每年49.7/100000人。其中，16例为HBV携带者，2例为丙型肝炎（HCV）携带者，2例为HBV和HCV合并感染。HBV感染的存在与HCC发生风险高78倍相关。通过超声或甲胎蛋白监测诊断HCC时，大多数（85%）患者无症状。所有通过监测诊断的患者均接受了积极治疗，而2/3有症状的患者只能接受对症治疗并很快死亡。总之，在HBV流行地区，HBV感染是肾移植受者发生HCC的主要病因。定期进行HCC监测似乎能够检测出适合治疗的早期癌症，并提供最佳的治愈希望。
