Elserwy Nabil Abdelfadil, Lotfy Esam Elden, Fouda Mohamad Ashraf, Mahmoud Medhat Ibrahim, Donia Ahmed Farouk, Mashaly Mohamed Elsayed, Abbas Mohamed Hamed, Abuelmagd Mohamed Megahed, Abouelenein Rasha Kamal, Ismail Mabrouk Ibrahim, Bakr Mohamed Adel
Department of Nephrology, The Urology-Nephrology Center, Mansoura, Egypt.
Department of Nephrology, Zagazig University, Zagazig, Egypt.
Saudi J Kidney Dis Transpl. 2017 May-Jun;28(3):579-588. doi: 10.4103/1319-2442.206456.
The newer and potent immunosuppressive agents have successfully reduced the risk of rejection after kidney transplantation, but the development of cardiovascular diseases, infections, and malignancy is major factors limiting their success. Posttransplantation malignancy is the second most common cause of death in renal transplant recipients after cardiovascular disease; it is expected that mortality due to malignancy may become the most common cause of death within the next two decades. This study is designed to evaluate the incidence, risk factors, and types of malignancies occurring after renal transplantation and their impact on patient and graft survival. A total of 2288 patients underwent living donor renal allotransplantation in the Urology and Nephrology Center, Mansoura University, during the period between 1975 and 2011. Among these patients, 100 patients developed posttransplantation malignancy. Patients were categorized into five major groups according to their type of malignancy; Kaposi's sarcoma (KS), non-Kaposi's skin tumors (non-KS), posttransplant lymphoproliferative disorders (PTLD), solid tumors, and genitourinary and reproductive system (GU and RS). Overall, the incidence of cancer in renal transplant recipients was 4%. There were 83 male (83%) and 17 female patients (17%). The most frequent cancer was KS seen in 33 patients (33%). The lowest median time to development of cancer was observed in KS (35 months). The highest median time to development of cancer was observed in PTLD (133 months). The best graft survival was observed in PTLD and the worst in non-KS tumors. The best patient survival was observed in KS and the worst in GU and RS tumors. Azathioprine-based regimen was associated with a higher rate of cancer. The number of patients who died was 65 (65%). Our results indicate that the occurrence of malignancy has an important impact on short- and long-term graft and patient survival.
新型强效免疫抑制剂已成功降低肾移植后排异反应的风险，但心血管疾病、感染及恶性肿瘤的发生是限制其成功的主要因素。移植后恶性肿瘤是肾移植受者仅次于心血管疾病的第二大常见死亡原因；预计在未来二十年内，恶性肿瘤导致的死亡率可能会成为最常见的死亡原因。本研究旨在评估肾移植后发生的恶性肿瘤的发病率、危险因素、类型及其对患者和移植物存活的影响。1975年至2011年期间，共有2288例患者在曼苏拉大学泌尿外科和肾病中心接受了活体供肾同种异体移植。在这些患者中，有100例发生了移植后恶性肿瘤。根据恶性肿瘤类型，患者被分为五大组：卡波西肉瘤（KS）、非卡波西皮肤肿瘤（非KS）、移植后淋巴细胞增殖性疾病（PTLD）、实体瘤以及泌尿生殖系统和生殖系统（GU和RS）。总体而言，肾移植受者的癌症发病率为4%。男性患者83例（83%），女性患者17例（17%）。最常见的癌症是KS，有33例患者（33%）。KS患者发生癌症的中位时间最短（35个月）。PTLD患者发生癌症的中位时间最长（133个月）。PTLD患者的移植物存活率最高，非KS肿瘤患者的移植物存活率最低。KS患者的患者存活率最高，GU和RS肿瘤患者的患者存活率最低。基于硫唑嘌呤的治疗方案与较高的癌症发生率相关。死亡患者有65例（65%）。我们的结果表明，恶性肿瘤的发生对移植物和患者的短期及长期存活有重要影响。
