University of Connecticut, Internal Medicine, 263 Farmington Avenue, Farmington, CT 06030-1235.
Cancer Treat Res Commun. 2021;26:100283. doi: 10.1016/j.ctarc.2020.100283. Epub 2020 Dec 11.
While transplant recipients are aware of increased malignancy risk, there is little consensus on the preventative measures. The goal of this review is to bring available preventative measures to light and prompt more research to be done with ultimate goal of developing an individualized prevention plan for each patient based on risk factors and available screening tools.
Transplant surgery offers patients with end-stage renal disease a longer life expectancy with help of immunosuppressive therapies. Nonetheless, life-long immunosuppression comes at a cost of post-renal transplant malignancies, which have become the leading cause of morbidity in this patient group.
Post-renal transplant cancers can develop through either de novo, by donor-related transmission, or recurrence of recipient's pre-transplant cancer. While immunosuppressive therapy is considered to be the leading cause, weakened immunosurveillance of neoplastic cells and inadequate immune response against oncogenic viruses also plays an important role. The most common cancers seen in renal transplant patients are skin cancers and post-transplant lymphoproliferative disorder (PTLD). Risk factors for skin cancers have are ultraviolet light, human papilloma virus infection, and use of cyclosporin and azathioprine. Numerous viral infections have been associated with transplant-related malignancies post-transplant.
While lowering of immunosuppressive therapy remains the treatment of choice, it may lead to graft failure. Given some of the presented malignancies have modifiable risk factors and options for screening, clinical outcomes can be improved. Limiting skin exposure, dermatologic screening, and prophylactic retinoids can help lower the incidence rate of skin malignancy. Endoscopic screening for renal transplant patients can help identify gastric adenocarcinoma early and improve survival rates. Some of the post-transplant malignancies have been responsive to anti-viral treatment.
尽管移植受者意识到恶性肿瘤风险增加，但对于预防措施仍缺乏共识。本综述的目的是阐明现有的预防措施，并促使开展更多研究，最终根据风险因素和现有筛查工具为每位患者制定个性化的预防计划。
移植手术为终末期肾病患者提供了更长的预期寿命，得益于免疫抑制疗法。然而，长期的免疫抑制治疗会带来移植后恶性肿瘤的风险，这已成为该患者群体发病率升高的主要原因。
移植后癌症可以通过新生、供体相关传播或受者移植前癌症的复发而发展。尽管免疫抑制治疗被认为是主要原因，但肿瘤细胞的免疫监视减弱和针对致癌病毒的免疫反应不足也起着重要作用。在肾移植患者中最常见的癌症是皮肤癌和移植后淋巴组织增生性疾病（PTLD）。皮肤癌的危险因素包括紫外线、人乳头瘤病毒感染以及环孢素和硫唑嘌呤的使用。许多病毒感染与移植后相关的恶性肿瘤有关。
虽然降低免疫抑制治疗仍然是首选治疗方法，但可能导致移植物失功。鉴于一些已呈现的恶性肿瘤具有可改变的风险因素和筛查选择，临床结果可以得到改善。限制皮肤暴露、皮肤科筛查和预防性维甲酸可以帮助降低皮肤恶性肿瘤的发生率。对肾移植患者进行内镜筛查有助于早期发现胃腺癌并提高生存率。一些移植后恶性肿瘤对抗病毒治疗有反应。
