McPherson Iain, Kirk Alan
1 The University of Aberdeen, UK.
2 Consultant Thoracic Surgeon, Golden Jubilee National Hospital, UK.
Scott Med J. 2018 Feb;63(1):3-10. doi: 10.1177/0036933017736423. Epub 2017 Oct 26.
Background Immunosuppression helps prevent acute rejection post-cardiac transplant but has been linked to malignancy development. This may be due to a reduction in T-lymphocyte function, a direct oncogenic effect or the increased impact of environmental carcinogens. There has been shown to be significant increases in non-melanoma skin cancers and post-transplant lympho-proliferative disorders, particularly in those treated with OKT3. Aim To investigate the survival and incidence of malignancy in the Scottish cardiac transplant population and whether rates of non-melanoma skin cancers justify the provision of specialist dermatological follow-up. Methods and results Retrospective case note analysis of patients transplanted (363) or followed up (2) in Scotland from 1992 to 2016. Kaplan-Meier survival analysis generated a survival curve. Patients had a 1-year survival of 82% and a median survival of 10.9 years. There were 60 (95% CI 47.5, 75.2) NMSCs and 8 (3.7, 12.4) post-transplant lympho-proliferative disorders diagnosed in the cohort (3110 person years follow-up). Fisher's exact test was employed to analyse the association between induction therapy (via OKT3 or rabbit antithymocyte globulin) and post-transplant lympho-proliferative disorder development. Patients treated with OKT3 had a 6.7 times greater risk ( P = 0.014) and a shorter experience of patients treated with rabbit antithymocyte globulin has so far shown no significantly altered risk ( P = 1.00) of developing a post-transplant lympho-proliferative disorder. Conclusion Incidences of non-melanoma skin cancers and post-transplant lympho-proliferative disorders were increased in the Scottish cardiac transplant population and there was a significant association between post-transplant lympho-proliferative disorder development and OKT3 therapy but not rabbit antithymocyte globulin therapy. These findings in Scottish patients reflect what is published in wider literature and support the provision of a dedicated post-transplant dermatology clinic.
背景 免疫抑制有助于预防心脏移植后的急性排斥反应，但与恶性肿瘤的发生有关。这可能是由于T淋巴细胞功能降低、直接致癌作用或环境致癌物影响增加所致。非黑色素瘤皮肤癌和移植后淋巴细胞增殖性疾病显著增加，尤其是在接受OKT3治疗的患者中。目的 调查苏格兰心脏移植人群中恶性肿瘤的生存率和发病率，以及非黑色素瘤皮肤癌的发病率是否足以证明需要提供专科皮肤科随访。方法和结果 对1992年至2016年在苏格兰接受移植（363例）或随访（2例）的患者进行回顾性病例记录分析。采用Kaplan-Meier生存分析生成生存曲线。患者1年生存率为82%，中位生存期为10.9年。该队列（3110人年随访）中诊断出60例（95%可信区间47.5, 75.2）非黑色素瘤皮肤癌和8例（3.7, 12.4）移植后淋巴细胞增殖性疾病。采用Fisher精确检验分析诱导治疗（通过OKT3或兔抗胸腺细胞球蛋白）与移植后淋巴细胞增殖性疾病发生之间的关联。接受OKT3治疗的患者发生移植后淋巴细胞增殖性疾病的风险高6.7倍（P = 0.014），而接受兔抗胸腺细胞球蛋白治疗的患者风险至今未显示出显著改变（P = 1.00）。结论 苏格兰心脏移植人群中非黑色素瘤皮肤癌和移植后淋巴细胞增殖性疾病的发病率增加，移植后淋巴细胞增殖性疾病的发生与OKT3治疗之间存在显著关联，但与兔抗胸腺细胞球蛋白治疗无关。苏格兰患者的这些发现反映了更广泛文献中的报道，并支持设立专门的移植后皮肤科诊所。
