From the Division of Gastroenterology and Hepatology.
Department of Transplantation, Mayo Clinic, Jacksonville, FL.
Pancreas. 2021 Jan 1;50(1):54-63. doi: 10.1097/MPA.0000000000001722.
Solid organ transplant (SOT) recipients have moderately increased risk of pancreatic adenocarcinoma (PAC). We evaluated the incidence and survival of PAC in 2 cohorts and aimed to identify potential risk factors.
This study performed a retrospective cohort analysis. Cohort A was extracted from the United Network of Organ Sharing data set and cohort B from SOT recipients evaluated at 3 Mayo Clinic transplant centers. The primary outcome was age-adjusted annual incidence of PAC. Descriptive statistics, hazard ratios, and survival rates were compared.
Cohort A and cohort B included 617,042 and 29,472 SOT recipients, respectively. In cohort A, the annual incidence rate was 12.78 per 100,000 in kidney-pancreas, 13.34 in liver, and 21.87 in heart-lung transplant recipients. Receiving heart-lung transplant, 50 years or older, and history of cancer (in either recipient or donor) were independent factors associated with PAC. Fifty-two patients developed PAC in cohort B. Despite earlier diagnosis (21.15% with stage I-II), survival rates were similar to those reported for sporadic (non-SOT) patients.
We report demographic and clinical risk factors for PAC after SOT, many of which were present before transplant and are common to sporadic pancreatic cancer. Despite the diagnosis at earlier stages, PAC in SOT portends a very poor survival.
实体器官移植（SOT）受者患胰腺导管腺癌（PAC）的风险略有增加。我们评估了 2 个队列中 PAC 的发病率和生存率，并旨在确定潜在的危险因素。
本研究进行了回顾性队列分析。队列 A 从器官共享联合网络数据集中提取，队列 B 从在梅奥诊所 3 个移植中心接受评估的 SOT 受者中提取。主要结局是年龄调整后的 PAC 年发病率。比较了描述性统计数据、风险比和生存率。
队列 A 和队列 B 分别包括 617,042 名和 29,472 名 SOT 受者。在队列 A 中，肾-胰移植受者的年发病率为 12.78/100,000，肝移植受者为 13.34/100,000，心肺移植受者为 21.87/100,000。接受心肺移植、50 岁或以上以及有癌症史（在受者或供者中）是与 PAC 相关的独立因素。队列 B 中有 52 名患者发生 PAC。尽管诊断较早（21.15%为 I-II 期），但生存率与非 SOT 患者报道的相似。
我们报告了 SOT 后 PAC 的人口统计学和临床危险因素，其中许多因素在移植前就存在，与散发性（非 SOT）胰腺癌常见。尽管在更早的阶段诊断出 PAC，但 SOT 患者的预后非常差。
