Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin, Berlin, Germany.
PLoS One. 2020 Nov 30;15(11):e0242805. doi: 10.1371/journal.pone.0242805. eCollection 2020.
De-novo malignancies after kidney transplantation represent one major cause for mortality after transplantation. However, most of the studies are limited due to small sample size, short follow-up or lack of information about cancer specific mortality.
This long-term retrospective analysis included all adult patients with complete follow-up that underwent kidney transplantation between 1995 and 2016 at our centre. All patients with diagnosis of malignancy excluding non-melanoma skin cancer (NMSC) were identified and a matched control group was assigned to the kidney transplant recipients with post-transplant malignancies.
1417 patients matched the inclusion criteria. 179 malignancies posttransplant were diagnosed in 154 patients (n = 21 with two, n = 2 patients with three different malignancies). Mean age at cancer diagnosis was 60.3±13.3 years. Overall incidence of de-novo malignancies except NMSC was 1% per year posttransplant. Renal cell carcinoma was the most common entity (n = 49, incidence 4.20 per 1000 patient years; cancer specific mortality 12%), followed by cancer of the gastro-intestinal tract (n = 30, 2.57; 50%), urinary system (n = 24, 2.06; 13%), respiratory system (n = 18, 1.54; 89%), female reproductive system (n = 15, 1.29; 13%), posttransplant lymphoproliferative disorders and haematological tumours (n = 14, 1.20; 21%), cancers of unknown primary (n = 7, 0.60 100%) and others (n = 22, 1.89; 27%). Male sex, re-transplantation and time on dialysis were associated with de-novo malignancies after transplantation.
De-novo malignancies continue to be a serious problem after kidney transplantation. To improve long-term outcome after Kidney transplantation, prevention and cancer screening should be more tailored and intensified.
肾移植后新发恶性肿瘤是移植后死亡的主要原因之一。然而，由于样本量小、随访时间短或缺乏癌症特异性死亡率信息，大多数研究受到限制。
本长期回顾性分析纳入了 1995 年至 2016 年期间在本中心接受肾移植的所有具有完整随访的成年患者。确定了所有诊断为恶性肿瘤（不包括非黑色素瘤皮肤癌[NMSC]）的患者，并为肾移植后患有恶性肿瘤的患者分配了匹配的对照组。
1417 例患者符合纳入标准。154 例患者中诊断出 179 例移植后恶性肿瘤（n=21 例有两种，n=2 例有三种不同的恶性肿瘤）。癌症诊断时的平均年龄为 60.3±13.3 岁。除 NMSC 外，新发恶性肿瘤的总体发生率为移植后每年 1%。肾细胞癌是最常见的实体瘤（n=49，发病率为每 1000 例患者 4.20 例；癌症特异性死亡率为 12%），其次是胃肠道癌（n=30，2.57；50%）、泌尿系统癌（n=24，2.06；13%）、呼吸系统癌（n=18，1.54；89%）、女性生殖系统癌（n=15，1.29；13%）、移植后淋巴增生性疾病和血液系统肿瘤（n=14，1.20；21%）、不明原发灶癌（n=7，0.60 100%）和其他肿瘤（n=22，1.89；27%）。男性、再次移植和透析时间与移植后新发恶性肿瘤有关。
肾移植后新发恶性肿瘤仍是一个严重的问题。为了改善肾移植后的长期预后，应更有针对性和强化预防和癌症筛查。
