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小儿肝移植受者的移植后恶性肿瘤:土耳其两个中心的经验

Post-transplant malignancies in pediatric liver transplant recipients: Experience of two centers in Turkey.

作者信息

Karakoyun Miray, Önen Şebnem, Baran Maşallah, Çakır Murat, Ömür Ecevit Çiğdem, Kılıç Murat, Kantar Mehmet, Aksoylar Serap, Özgenç Funda, Aydoğdu Sema

机构信息

Department of Pediatric Gastroenterology, Hepatology and Nutrition, Tepecik Training and Research Hospital, İzmir, Turkey.

Department of Pediatrics, Ege University School of Medicine, İzmir, Turkey.

出版信息

Turk J Gastroenterol. 2018 Jan;29(1):89-93. doi: 10.5152/tjg.2017.17089.

Abstract

BACKGROUND/AIMS: A liver transplant is the preferred treatment for patients with end-stage liver disease, as it usually results in longterm survival. However, due to the use of chronic immunosuppressive therapy, which is necessary to prevent rejection, de novo cancer is a major risk after transplantation. The aim of this study was to assess the incidence of post-transplant malignancies in children after liver transplantations.

MATERIALS AND METHODS

The study group consisted of 206 liver transplant recipients, with no history of cancer, including hepatocellular carcinoma, in two liver transplantation centers in Turkey between 1997 and 2015. Data were obtained from patient's data chart.

RESULTS

In the study group, de novo cancer was diagnosed in 13 of the 206 patients. Post-transplant lymphoproliferative disease (PTLD) occurred in seven (53.8%) patients and other malignancies in six of the 13 patients. The types of PTLD were as follows: B-cell origin (n=2), Epstein-Barr virus (EBV)-related (n=2), T-cell origin (n=1), and Hodgkin's lymphoma (n=2). EBV DNA was isolated from seven patients, three of whom developed PTLD. The others developed Kaposi's sarcomas, Burkitt's lymphomas, cutaneous large-cell lymphomas, Hodgkin's lymphomas, and liver sarcomas.

CONCLUSION

After transplantation, immunosuppressive treatment is unavoidable, increasing the risk of malignancies. However, a close follow-up and periodic screening can reduce cancer-related mortality and morbidity.

摘要

背景/目的:肝移植是终末期肝病患者的首选治疗方法,因为它通常能带来长期生存。然而,由于预防排斥反应所需的慢性免疫抑制治疗的使用,新发癌症是移植后的主要风险。本研究的目的是评估儿童肝移植后移植后恶性肿瘤的发生率。

材料与方法

研究组由1997年至2015年期间土耳其两个肝移植中心的206名无癌症病史(包括肝细胞癌)的肝移植受者组成。数据从患者病历中获取。

结果

在研究组中,206名患者中有13名被诊断为新发癌症。移植后淋巴细胞增生性疾病(PTLD)发生在7名(53.8%)患者中,其他恶性肿瘤发生在13名患者中的6名。PTLD的类型如下:B细胞起源(n = 2)、爱泼斯坦-巴尔病毒(EBV)相关(n = 2)、T细胞起源(n = 1)和霍奇金淋巴瘤(n = 2)。从7名患者中分离出EBV DNA,其中3名发展为PTLD。其他患者发展为卡波西肉瘤、伯基特淋巴瘤、皮肤大细胞淋巴瘤、霍奇金淋巴瘤和肝肉瘤。

结论

移植后,免疫抑制治疗不可避免,增加了患恶性肿瘤的风险。然而,密切随访和定期筛查可以降低癌症相关的死亡率和发病率。

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