Department of Nephrology and Kidney Transplantation, Beaumont Hospital Dublin, Ireland.
Royal College of Surgeons in Ireland, Dublin, Ireland.
JAMA Dermatol. 2019 May 1;155(5):594-598. doi: 10.1001/jamadermatol.2018.4660.
Existing data suggest that nonmelanoma skin cancer (NMSC) is more common in renal transplant recipients than in maintenance dialysis patients. However, whether the risk of NMSC varies as the treatment modality for end-stage kidney disease (ESKD) changes between dialysis and transplantation is not well described.
To determine whether the incidence of NMSC is attenuated during periods of graft loss with a return to dialysis in those who receive multiple kidney transplants.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of data from recipients of kidney transplants from the Irish National Kidney Transplant Service database, linked with the Irish Cancer Registry, from 1994 to 2014. All analysis took place between January 10, 2018 and March 31, 2018. Standardized incidence ratios (SIRs) were calculated for NMSC incidence in comparison with the general population using Irish census data as the denominator. Incidence of NMSC was calculated with modality of treatment for ESKD varying over time; incidence rates and rate ratios associated with dialysis intervals were calculated using Poisson regression; and disease was defined according to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for cancer diagnosis.
Kidney transplantation.
Incidence rates per 1000 patient-years and incident rate ratios of NMSC after kidney transplant.
Data from the records of 3821 deceased or living donor kidney transplant recipients were assessed; 2399 (62.8%) male and 1422 (37.2%) female recipients; mean (SD) age at time of first data recorded, 41.9 (16.0) years. A total of 3433 recipients were included who had a functioning transplant on January 1, 1994, or received a transplant after that date up to December 31, 2014: 3215 received 1 transplant, 522 a second kidney transplant, and 84 had 3 or more kidney transplants. Periods of treatment with a functioning transplant were associated with a higher incidence of NMSC diagnosis than periods of graft failure: adjusted incidence rate ratio (aIRR), 2.19 (95% CI, 1.56-3.07), P < .001. The aIRRs of NMSC fell from 41.7 (95% CI, 39.38-44.15) per 1000 patient-years in the first transplant to 19.29 (95% CI, 13.41-27.76) in the dialysis period following the first allograft failure. Incidence similarly rose and fell following each subsequent consecutive transplant.
In recipients of multiple kidney transplants, while the incidence of NMSC fell during periods defined by transplant failure, there was residual elevated risk. While ascertainment bias may have contributed to the observed trends, the stagnant incidence of invasive cancer overall highlights the need for continued cancer surveillance during graft failure.
现有数据表明，非黑色素瘤皮肤癌（NMSC）在肾移植受者中比维持性透析患者更为常见。然而，终末期肾病（ESKD）的治疗方式在透析和移植之间发生变化时，NMSC 的风险是否会发生变化尚不清楚。
确定在多次肾移植受者中，随着移植物丢失并恢复透析，NMSC 的发病率是否会降低。
设计、地点和参与者：对爱尔兰国家肾脏移植服务数据库中肾移植受者的数据进行回顾性分析，该数据库与爱尔兰癌症登记处相关联，时间范围为 1994 年至 2014 年。所有分析均于 2018 年 1 月 10 日至 2018 年 3 月 31 日之间进行。使用爱尔兰人口普查数据作为分母，计算 NMSC 发病率与普通人群的标准化发病率比（SIRs）。根据 ESKD 的治疗方式随时间变化而变化，计算 NMSC 的发病率；使用泊松回归计算与透析间隔相关的发病率和发病率比；根据国际疾病分类和相关健康问题第十次修订版癌症诊断代码定义疾病。
肾移植。
每 1000 名患者年的发病率和肾移植后 NMSC 的发病率比。
对 3821 名已故或活体供体肾移植受者的记录数据进行了评估；2399 名（62.8%）男性和 1422 名（37.2%）女性受者；首次记录数据时的平均（SD）年龄为 41.9（16.0）岁。共有 3433 名受者被纳入研究，他们在 1994 年 1 月 1 日或之后的日期有功能移植：3215 名受者接受了 1 次移植，522 名受者接受了第 2 次肾移植，84 名受者接受了 3 次或更多次肾移植。与移植物衰竭期相比，具有功能移植的治疗期与更高的 NMSC 诊断发病率相关：调整后的发病率比（aIRR）为 2.19（95%CI，1.56-3.07），P < 0.001。NMSC 的 aIRR 从首次移植的 41.7（95%CI，39.38-44.15）/1000 患者年降至首次同种异体移植物失败后透析期的 19.29（95%CI，13.41-27.76）。随后每次连续移植后，发病率也随之上升和下降。
在多次肾移植受者中，虽然 NMSC 的发病率在移植失败期间有所下降，但仍存在残留的高风险。虽然确定偏差可能导致了观察到的趋势，但整体侵袭性癌症发病率的稳定强调了在移植物衰竭期间需要继续进行癌症监测。
