Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia.
Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
Nat Rev Nephrol. 2018 Aug;14(8):508-520. doi: 10.1038/s41581-018-0022-6.
Cancer is the second most common cause of mortality and morbidity in kidney transplant recipients after cardiovascular disease. Kidney transplant recipients have at least a twofold higher risk of developing or dying from cancer than the general population. The increased risk of de novo and recurrent cancer in transplant recipients is multifactorial and attributed to oncogenic viruses, immunosuppression and altered T cell immunity. Transplant candidates and potential donors should be screened for cancer as part of the assessment process. For potential recipients with a prior history of cancer, waiting periods of 2-5 years after remission - largely depending on the cancer type and stage of initial cancer diagnosis - are recommended. Post-transplantation cancer screening needs to be tailored to the individual patient, considering the cancer risk of the individual, comorbidities, overall prognosis and the screening preferences of the patient. In kidney transplant recipients diagnosed with cancer, treatment includes conventional approaches, such as radiotherapy and chemotherapy, together with consideration of altering immunosuppression. As the benefits of transplantation compared with dialysis in potential transplant candidates with a history of cancer have not been assessed, current clinical practice relies on evidence from observational studies and registry analyses.
癌症是继心血管疾病之后导致肾移植受者死亡和发病的第二大常见原因。与普通人群相比，肾移植受者罹患癌症或死于癌症的风险至少高出两倍。移植受者新发和复发性癌症的风险是多因素的，归因于致癌病毒、免疫抑制和 T 细胞免疫改变。作为评估过程的一部分，应筛选移植候选人和潜在供体是否患有癌症。对于有癌症既往史的潜在受者，建议在缓解后等待 2-5 年（主要取决于癌症类型和初始癌症诊断的阶段）。移植后癌症筛查需要根据个体患者的情况进行调整，考虑个体的癌症风险、合并症、总体预后和患者的筛查偏好。在诊断患有癌症的肾移植受者中，治疗包括放疗和化疗等常规方法，并考虑改变免疫抑制。由于尚未评估有癌症病史的潜在移植受者中移植与透析相比的获益，因此目前的临床实践依赖于观察性研究和登记分析的证据。
