Carenco Christophe, Faure Stéphanie, Herrero Astrid, Assenat Eric, Duny Yohan, Danan Guillaume, Bismuth Michaël, Chanques Gérald, Ursic-Bedoya José, Jaber Samir, Larrey Dominique, Navarro Francis, Pageaux Georges-Philippe
Digestive department, Liver Transplantation Unit - Saint-Eloi Hospital, Monterpellier, France.
Liver Int. 2015 Jun;35(6):1748-55. doi: 10.1111/liv.12758. Epub 2015 Jan 21.
BACKGROUND & AIMS: Increased rates of solid organ cancers post-liver transplantation have been reported, but the contribution of environmental factors and immunosuppressive therapy is not clear. This study's aims were to compare the incidence of de novo solid organ cancers after liver transplantation; identify risk factors independent of immunosuppressive therapy associated with these cancers; and assess the influence of calcineurin inhibitors on the appearance of these cancers.
This single-centre study from 1991 to 2008 included 465 liver recipients who had survived for ≥1 year. Gross incidence rates were standardized by age and sex, using the global population as a reference. In addition, 322 of the 465 patients treated for ≥1 year with calcineurin inhibitors were studied.
Sixty-five (13.9%) of the 465 patients developed de novo solid cancers. The overall relative risk was 3.7. Significantly increased relative risks were observed for digestive, oesophageal, colorectal, oral and lung cancers, but not for genito-urinary and breast cancers. Among the 65 patients who developed solid organ cancers, 43 died (66.1%), 41 from cancer. The two independent risk factors were pretransplant smoking [P < 0.0001; odds ratio = 5.5 (.5; 12)] and obesity [P = 0.0184; odds ratio = 2.2 (1.1; 4.3)]. Of the 322 patients on calcineurin inhibitors, 55 (17%) developed de novo solid cancers. Tacrolimus exposure level was a risk factor for de novo solid cancers [P < 0.0001; OR = 15.3 (4.5; 52.2)].
We recommend a change in immunosuppressive protocols with lifestyle/dietary guidelines and smoking cessation.
已有报道称肝移植后实体器官癌症的发病率有所上升，但环境因素和免疫抑制治疗的作用尚不清楚。本研究的目的是比较肝移植后新发实体器官癌症的发病率；确定与这些癌症相关的独立于免疫抑制治疗的危险因素；并评估钙调神经磷酸酶抑制剂对这些癌症发生的影响。
这项1991年至2008年的单中心研究纳入了465名存活≥1年的肝移植受者。粗发病率按年龄和性别进行标准化，以全球人口作为参考。此外，对465名接受钙调神经磷酸酶抑制剂治疗≥1年的患者中的322名进行了研究。
465名患者中有65名（13.9%）发生了新发实体癌。总体相对风险为3.7。在消化系统、食管癌、结直肠癌、口腔癌和肺癌中观察到相对风险显著增加，但在泌尿生殖系统癌和乳腺癌中未观察到。在发生实体器官癌症的65名患者中，43名死亡（66.1%），其中41名死于癌症。两个独立的危险因素是移植前吸烟[P < 0.0001；比值比 = 5.5（0.5；12）]和肥胖[P = 0.0184；比值比 = 2.2（1.1；4.3）]。在322名接受钙调神经磷酸酶抑制剂治疗的患者中，55名（17%）发生了新发实体癌。他克莫司暴露水平是新发实体癌的一个危险因素[P < 0.0001；OR = 15.3（4.5；52.2）]。
我们建议结合生活方式/饮食指南和戒烟改变免疫抑制方案。
