Cardiovascular Outcomes Research Laboratories (CORELAB) at the David Geffen School of Medicine, University of California, Los Angeles.
Division of Cardiac Surgery, University of California, Los Angeles.
Surgery. 2019 Jun;165(6):1228-1233. doi: 10.1016/j.surg.2019.01.008. Epub 2019 Mar 1.
Malignancy is a relative contraindication in transplant candidates, given the increased neoplastic risk accompanying posttransplant immunosuppression. However, the number of patients receiving a lung transplant despite pretransplant malignancy is rising, and their outcomes remain unclear. Our purpose was to examine the outcomes of lung transplant recipients with pretransplant malignancy in the modern era.
We evaluated the United Network for Organ Sharing registry for adult lung transplants that were completed between June 2005 and September 2016. Transplant recipients were stratified by pretransplant malignancy, with subgroup analysis by sex and active malignancy. The primary outcome was 5-year survival and the secondary outcome was cause of death. Kaplan-Meier estimates illustrated 5-year survival and multivariable Cox proportional hazards regressions controlled for demographics and comorbidities.
Of 18,032 transplant patients, 1,321 transplant recipients (7.3%) possessed a pretransplant malignancy. Patients with pretransplant malignancy faced significantly greater mortality within 5 years (36.0% vs 32.8%, P = .017), an effect greatest in men with pretransplant malignancy (39.2% vs 33.7%, P = .002). Patients with pretransplant malignancy also faced greater risk of death from posttransplant malignancy (15.6% vs 9.4%, P < .001), particularly for those with active malignancy at transplant (34.8% vs 9.8%, P < .001). Pretransplant malignancy remained a significant predictor of 5-year mortality in adjusted Cox regressions (hazard ratio: 1.16 [1.05-1.27], P = .003).
Patients with pretransplant malignancy, and particularly men with pretransplant malignancy and those with active malignancy at transplant, are at an increased risk of 5-year mortality and posttransplant death from malignancy. Balancing individual risk of posttransplant malignancy with immunosuppressive care is necessary to optimize outcomes for pretransplant malignancy patients.
由于移植后免疫抑制会增加肿瘤风险，因此恶性肿瘤是移植候选者的相对禁忌症。然而，尽管存在恶性肿瘤，仍有越来越多的患者接受了肺移植，其结局尚不清楚。我们的目的是研究现代时期患有移植前恶性肿瘤的肺移植受者的结局。
我们评估了 2005 年 6 月至 2016 年 9 月期间完成的美国器官共享网络成人肺移植登记处。根据移植前恶性肿瘤对移植受者进行分层，并根据性别和活动性恶性肿瘤进行亚组分析。主要结局是 5 年生存率，次要结局是死亡原因。Kaplan-Meier 估计说明了 5 年生存率，多变量 Cox 比例风险回归控制了人口统计学和合并症。
在 18032 例移植患者中，有 1321 例（7.3%）移植受者患有移植前恶性肿瘤。患有移植前恶性肿瘤的患者在 5 年内的死亡率明显更高（36.0%对 32.8%，P=0.017），在患有移植前恶性肿瘤的男性中这一效应最大（39.2%对 33.7%，P=0.002）。患有移植前恶性肿瘤的患者也面临更高的移植后恶性肿瘤死亡风险（15.6%对 9.4%，P<.001），尤其是在移植时患有活动性恶性肿瘤的患者（34.8%对 9.8%，P<.001）。在调整后的 Cox 回归中，移植前恶性肿瘤仍然是 5 年死亡率的显著预测因素（风险比：1.16[1.05-1.27]，P=0.003）。
患有移植前恶性肿瘤的患者，特别是患有移植前恶性肿瘤的男性和移植时患有活动性恶性肿瘤的患者，其 5 年死亡率和移植后因恶性肿瘤死亡的风险增加。平衡移植前恶性肿瘤患者的移植后恶性肿瘤风险与免疫抑制治疗，对于优化其结局至关重要。
