From the School of Medicine, China Medical University, Taichung, Taiwan.
Exp Clin Transplant. 2020 Apr;18(2):224-233. doi: 10.6002/ect.2019.0210. Epub 2020 Mar 4.
In the Asian population, patterns and risk factors for de novo malignancies after solid-organ transplant are not well understood.
Insurance claims from Taiwan's National Health Institute Research Database from 1997 to 2011 revealed 687 deceased-donor heart transplant recipients, 5038 kidney transplant recipients (50% living related-donor, 50% deceased-donor transplants), and 2127 liver transplant recipients (mainly living related-donor transplants, 30% deceased-donor transplants). During the follow-up period, rates of malignancy incidence were calculated with standardization based on national age, sex, and year-specific incidence. We used multivariate regression analyses to determine risk factors of posttransplant de novo malignancies.
Compared with the general population, several de novo cancers were more common posttransplant (P < .05): lung cancer (2.6-fold), non-melanoma skin cancer (5.8-fold), and non-Hodgkin lymphoma (5.4-fold) in heart recipients; transitional cell carcinoma (31.4-fold), renal cell carcinoma (37.3-fold), and non-Hodgkin lymphoma (3.6-fold) in kidney recipients; and gastric cancer (3.0-fold) and lymphatic-hematopoietic malignancy (4.5-fold) in liver recipients. Independent risk factors for posttransplant malignancy in kidney transplant recipients were increased age, female, hepatitis B virus, and mycophenolate use (adjusted hazard ratio 1.5; 95% confidence interval, 1.2-1.8; P < .001). In liver transplant recipients, old age was an independent risk factor. Kidney transplant recipients without diabetes or hypertension had higher risk of transitional cell carcinoma (adjusted hazard ratio 3.0; 95% confidence interval, 2.1-4.4; P < .001) and renal cell carcinoma (adjusted hazard ratio 1.9; 95% confidence interval, 1.1-3.3; P < .05).
Regional endemic epidemiologic factors play significant roles in the development of de novo cancers, particularly in kidney transplant recipients due to causes of renal failure other than diabetes and hypertension. Each regional organ transplant program should tailor and establish its surveillance protocol based on epidemiologic data. However, the type and intensity of surveillance require further and long-term investigations in this patient cohort.
在亚洲人群中，实体器官移植后新发恶性肿瘤的模式和危险因素尚不清楚。
本研究使用 1997 年至 2011 年台湾全民健康保险研究数据库中的保险理赔数据，纳入 687 例心脏移植受者（687 例均为尸肾）、5038 例肾移植受者（50%为活体亲属供肾，50%为尸肾移植）和 2127 例肝移植受者（主要为活体亲属供肝，30%为尸肝移植）。在随访期间，根据国家年龄、性别和特定年份的发病率对恶性肿瘤发病率进行标准化计算。我们使用多变量回归分析来确定移植后新发恶性肿瘤的危险因素。
与普通人群相比，心脏移植受者中几种新发癌症更为常见（P<0.05）：肺癌（2.6 倍）、非黑素瘤皮肤癌（5.8 倍）和非霍奇金淋巴瘤（5.4 倍）；肾移植受者中移行细胞癌（31.4 倍）、肾细胞癌（37.3 倍）和非霍奇金淋巴瘤（3.6 倍）；肝移植受者中胃癌（3.0 倍）和淋巴血液恶性肿瘤（4.5 倍）。肾移植受者发生移植后恶性肿瘤的独立危险因素为年龄增加、女性、乙型肝炎病毒和霉酚酸使用（调整后的危险比 1.5；95%置信区间，1.2-1.8；P<0.001）。在肝移植受者中，高龄是独立的危险因素。无糖尿病或高血压的肾移植受者发生移行细胞癌（调整后的危险比 3.0；95%置信区间，2.1-4.4；P<0.001）和肾细胞癌（调整后的危险比 1.9；95%置信区间，1.1-3.3；P<0.05）的风险更高。
区域流行的流行病学因素在新发癌症的发生中起着重要作用，特别是在因糖尿病和高血压以外的原因导致肾衰竭的肾移植受者中。每个区域器官移植项目都应根据流行病学数据制定和调整其监测方案。然而，这种患者队列中还需要进一步和长期的监测类型和强度的调查。
