Hope Christopher M, Krige Alice J, Barratt Alex, Carroll Robert P
Central Northern Adelaide Renal and Transplantation Service (CNARTS), Adelaide, SA, Australia.
Centre for Clinical and Experimental Transplantation (CCET), Royal Adelaide Hospital, Adelaide, SA, Australia.
Transpl Int. 2015 Nov;28(11):1332-5. doi: 10.1111/tri.12638. Epub 2015 Jul 29.
Few data exist on how immunosuppression is altered in kidney transplant recipients (KTR) following a diagnosis of cancer. This study investigated how immunosuppression was altered in KTR after cancer diagnosis and its effect on patient and graft survival. All KTR diagnosed with cancer at our centre from 1990 to 2012 were assessed. Drug regime and serum creatinine levels were recorded 1 year before, at time of, and 1 year after cancer diagnosis. Of 87 KTR who developed cancer (7.3% of transplanted population, n = 1189), 30 developed haematological malignancies and 57 developed solid organ cancers (SOC). In total, 38% of KTR presented with nodal or metastatic disease and 23 of 87 (26%) KTR died within 6 months of cancer diagnosis. Fifty-five KTR had records of pre- and postcancer diagnosis drug regimes. Thirty-six KTR had a (>50%) dose reduction or cessation of 1 or more immunosuppressive agents, and 19 no reduction in immunosuppression. In total, 2 of 36 (6%) of KTR who underwent a dose reduction suffered acute rejection that was reversed with methylprednisolone. Dose reduction/cessation of immunosuppression did not impair graft function, but also did not affect cancer free survival. Further larger prospective studies are needed to determine whether dose reduction alters relapse free cancer survival in KTR.
关于肾移植受者（KTR）在诊断出癌症后免疫抑制如何变化的数据很少。本研究调查了KTR在癌症诊断后免疫抑制的变化情况及其对患者和移植物存活的影响。对1990年至2012年在我们中心被诊断出患有癌症的所有KTR进行了评估。记录了癌症诊断前1年、诊断时以及诊断后1年的用药方案和血清肌酐水平。在87例发生癌症的KTR中（占移植人群的7.3%，n = 1189），30例发生血液系统恶性肿瘤，57例发生实体器官癌症（SOC）。总共有38%的KTR出现淋巴结或转移性疾病，87例中的23例（26%）KTR在癌症诊断后6个月内死亡。55例KTR有癌症诊断前后用药方案的记录。36例KTR对1种或更多免疫抑制剂进行了（>50%）剂量减少或停用，19例未减少免疫抑制。在总共36例进行剂量减少的KTR中，有2例（6%）发生急性排斥反应，经甲泼尼龙治疗后逆转。免疫抑制剂的剂量减少/停用并未损害移植物功能，但也未影响无癌生存期。需要进一步开展更大规模的前瞻性研究来确定剂量减少是否会改变KTR的无复发生存期。
