Fuchs Uwe, Klein Sarah, Zittermann Armin, Ensminger Stephan M, Schulz Uwe, Gummert Jan F
Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphaliay, Ruhr University Bochum, Bad Oeynhausen, Germany.
Ann Transplant. 2014 Jun 23;19:300-4. doi: 10.12659/AOT.890199.
Heart transplant recipients are at increased risk of developing malignant neoplasms. Administration of the calcineurin inhibitors cyclosporine A (CSA) or tacrolimus (TAC) may contribute to this risk.
We compared tumor incidence in heart transplant recipients receiving either CSA (n=25) or TAC (n=120) as maintenance immunosuppressive therapy. Exclusion criteria were therapy with mammalian target of rapamycin-inhibitors, death within the first postoperative year, re-transplantation, and age less than 18 years.
The 2 study groups were comparable with respect to sex, primary and concomitant diagnoses, and mean follow-up (60.7 ± 19.3 months in the CSA group vs. 59.8 ± 18.1 months in the TAC group; P=0.81). The CSA group was, however, significantly older compared with the TAC group (58.8 ± 11.4 years vs. 49.1 ± 13.0 years, P=0.001), as was the donor age of the CSA group (43.2 ± 11.2 years vs. 37.0 ± 11.7 years, P=0.02). In the CSA group, 5 patients (20%) developed malignant neoplasms compared with 10 patients (8.3%) in the TAC group (P=0.14). Covariate-adjusted 5-year tumor-free survival was comparable between groups (relative risk for the CSA group =1.162 [95% CI: 0.378-3.572; P=0.794]). Moreover, covariate-adjusted 5-year overall survival did not differ between the 2 groups (relative risk for the CSA group =1.95 [95% CI: 0.53-7.19; P=0.36). The incidence of infection, acute rejection, graft vasculopathy, renal failure, and neurological complications was also comparable between the 2 groups.
Our data indicate that tumor incidence does not significantly differ in patients receiving CSA or TAC as maintenance therapy.
心脏移植受者发生恶性肿瘤的风险增加。使用钙调神经磷酸酶抑制剂环孢素A（CSA）或他克莫司（TAC）可能会增加这种风险。
我们比较了接受CSA（n = 25）或TAC（n = 120）作为维持免疫抑制治疗的心脏移植受者的肿瘤发生率。排除标准包括使用雷帕霉素靶蛋白抑制剂治疗、术后第一年内死亡、再次移植以及年龄小于18岁。
两个研究组在性别、原发性和伴随诊断以及平均随访时间方面具有可比性（CSA组为60.7±19.3个月，TAC组为59.8±18.1个月；P = 0.81）。然而，CSA组的年龄明显大于TAC组（58.8±11.4岁对49.1±13.0岁，P = 0.001），CSA组的供体年龄也是如此（43.2±11.2岁对37.0±11.7岁，P = 0.02）。CSA组有5例患者（20%）发生恶性肿瘤，而TAC组有10例患者（8.3%）发生恶性肿瘤（P = 0.14）。两组之间经协变量调整的5年无瘤生存率相当（CSA组的相对风险=1.162 [95% CI：0.378 - 3.572；P = 0.794]）。此外，两组之间经协变量调整的5年总生存率没有差异（CSA组的相对风险=1.95 [95% CI：0.53 - 7.19；P = 0.36]）。两组之间感染、急性排斥反应、移植血管病变、肾衰竭和神经并发症的发生率也相当。
我们的数据表明，接受CSA或TAC作为维持治疗的患者的肿瘤发生率没有显著差异。
