Aguiar B, Santos Amorim T, Romãozinho C, Santos L, Macário F, Alves R, Campos M, Mota A
Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Nephrology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Transplant Proc. 2015 May;47(4):976-80. doi: 10.1016/j.transproceed.2015.03.039.
It is known that the incidence of malignancy in transplant recipients is higher than in the general population, with a more aggressive behavior and a worse outcome. In fact, malignancy is the third most common cause of death among kidney transplant (KT) recipients, after cardiovascular events and infections. The aim of this study was to investigate the incidence and characteristics of malignancies after KT in a single center. A total of 2353 patients who underwent KT between 1987 and 2012 were retrospectively studied. The results were compared with a group without cancer. During the follow-up period leading to August 2014, which included a median duration of 126.3 ± 81.8 months, 223 malignancies (9.4%) were diagnosed, which were the cause of death in 59 patients. Patients with cancer were older, had a longer duration of graft function, and had more episodes of acute rejection (AR), and a higher number of patients were treated with azathioprine and cyclosporine as initial immunosuppressive regime (P = .001). The most frequent malignancy was skin cancer (28.7%), followed by malignant lymphoma (12.1%) and kidney cancer (10.8%). The mean age of patients at diagnosis was 58.0 ± 11.1 years. The average time for development of a cancer was 7.5 ± 5.8 years, with 43.2% detected between 1 and 5 years. Patient survival was significantly lower among subjects with cancer, and censored graft survival was significantly higher in this group (P = .001). Multivariate logistic regression analysis showed that recipients' age and acute rejection episode are risk factors for development of post-kidney transplantation malignancy.
众所周知，移植受者中恶性肿瘤的发生率高于普通人群，其行为更具侵袭性，预后更差。事实上，恶性肿瘤是肾移植（KT）受者中第三大常见死因，仅次于心血管事件和感染。本研究的目的是调查单中心肾移植后恶性肿瘤的发生率和特征。对1987年至2012年间接受肾移植的2353例患者进行了回顾性研究。将结果与无癌症组进行比较。在截至2014年8月的随访期间，中位随访时间为126.3±81.8个月，诊断出223例恶性肿瘤（9.4%），其中59例患者因恶性肿瘤死亡。患癌症的患者年龄更大，移植肾功能持续时间更长，急性排斥反应（AR）发作次数更多，且更多患者最初接受硫唑嘌呤和环孢素作为免疫抑制方案治疗（P = 0.001）。最常见的恶性肿瘤是皮肤癌（28.7%），其次是恶性淋巴瘤（12.1%）和肾癌（10.8%）。诊断时患者的平均年龄为58.0±11.1岁。发生癌症的平均时间为7.5±5.8年，43.2%在1至5年之间被检测到。患癌症患者的总体生存率显著较低，而该组中截尾移植生存率显著较高（P = 0.001）。多因素logistic回归分析表明，受者年龄和急性排斥反应发作是肾移植后发生恶性肿瘤的危险因素。
