1 Division of Nephrology, UCLA Medical Center, Los Angeles, CA. 2 Division of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA.
Transplantation. 2017 Jun;101(6):1303-1309. doi: 10.1097/TP.0000000000001286.
Posttransplant malignancy (PTM) is one of the leading causes of late death in kidney recipients. Those with a cancer history may be more prone to develop a recurrent or a new cancer. We studied the association between pretransplant skin cancer, PTM, death, and graft failure.
Primary adult kidney recipients transplanted between 2005 and 2013 were included. Malignancy information was obtained from Organ Procurement Kidney Transplant Network/United Network for Organ Sharing registration and follow-up forms. Posttransplant malignancy was classified into skin cancer, solid tumor, and posttransplant lymphoproliferative disorder (PTLD). Competing risk and survival analysis with adjustment for confounders were used to calculate risk for PTM, death and graft failure in recipients with pretransplant skin cancer compared with those without cancer. Risk was reported in hazard ratios (HR) with 95% confidence interval (CI).
The cohort included 1671 recipients with and 102 961 without pretransplant skin malignancy. The 5-year cumulative incidence of PTM in patients with and without a pretransplant skin cancer history was 31.6% and 7.4%, respectively (P < 0.001). Recipients with pretransplant skin cancer had increased risk of PTM (sub-HR [SHR], 2.60; 95% CI, 2.27-2.98), and posttransplant skin cancer (SHR, 2.92; 95% CI, 2.52-3.39), PTLD (SHR, 1.93; 95% CI, 1.01-3.66), solid tumor (SHR, 1.44; 95% CI, 1.04-1.99), death (HR, 1.20; 95% CI, 1.07-1.34), and graft failure (HR, 1.17; 95% CI, 1.05-1.30) when compared with those without pretransplant malignancy.
Pretransplant skin cancer was associated with an increased risk of posttransplant skin cancer, PTLD, solid organ cancer, death and graft failure.
移植后恶性肿瘤（PTM）是肾移植受者晚期死亡的主要原因之一。有癌症病史的患者可能更容易复发或新发癌症。我们研究了移植前皮肤癌、PTM、死亡和移植物衰竭之间的关联。
纳入 2005 年至 2013 年间接受初次成人肾移植的患者。从器官获取和肾脏移植网络/联合器官共享网络登记和随访表中获取恶性肿瘤信息。将移植后恶性肿瘤分为皮肤癌、实体瘤和移植后淋巴组织增生性疾病（PTLD）。使用竞争风险和调整混杂因素的生存分析，比较移植前有皮肤癌和无皮肤癌的受者发生 PTM、死亡和移植物衰竭的风险。风险以风险比（HR）和 95%置信区间（CI）报告。
该队列包括 1671 例有和 102961 例无移植前皮肤恶性肿瘤的患者。有和无移植前皮肤癌史的患者在 5 年内 PTM 的累积发生率分别为 31.6%和 7.4%（P<0.001）。有移植前皮肤癌的患者发生 PTM 的风险增加（亚风险比 [SHR]，2.60；95%CI，2.27-2.98）、移植后皮肤癌（SHR，2.92；95%CI，2.52-3.39）、PTLD（SHR，1.93；95%CI，1.01-3.66）、实体瘤（SHR，1.44；95%CI，1.04-1.99）、死亡（HR，1.20；95%CI，1.07-1.34）和移植物衰竭（HR，1.17；95%CI，1.05-1.30），与无移植前恶性肿瘤的患者相比。
移植前皮肤癌与移植后皮肤癌、PTLD、实体器官癌、死亡和移植物衰竭的风险增加相关。
