Department of Surgery, The University of Cincinnati, OH; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, The University of Cincinnati, OH. Electronic address: https://twitter.com/AaronDelman.
Department of Surgery, The University of Cincinnati, OH; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, The University of Cincinnati, OH. Electronic address: https://twitter.com/KevinTurnerMD.
Surgery. 2022 Jan;171(1):220-226. doi: 10.1016/j.surg.2021.03.064. Epub 2021 Jul 22.
Pretransplant malignancy is associated with decreased patient and graft survival. Current US guidelines recommend a 2- to 5-year, tumor-free waiting period before transplantation. No large studies have examined the specific, modern day risk of pretransplant thyroid malignancy on patient and graft survival after renal transplant.
The United Network for Organ Sharing database was queried for all adult isolated renal transplant recipients between 2003 and 2019. Patient characteristics, rates of post-transplant malignancy, and survival were compared between patients with pretransplant thyroid malignancy and without pretransplant thyroid malignancy.
Eighty-six patients had pretransplant thyroid malignancy diagnosed after listing and before renal transplantation. Both overall and graft survival were similar between cohorts (P > .05). There was no significant association between pretransplant thyroid malignancy and patient (hazard ratio: 0.66; P = .31) or graft (hazard ratio:0.32; P = .11) survival on multivariate analysis. Waitlist duration for pretransplant thyroid malignancy patients was significantly increased (1,444 vs 438 days; P < .01), which translated to increased dialysis duration (2,234 vs 1,201 days, P < .01). Pretransplant thyroid malignancy patients did not experience increased post-transplant malignancy (P = .21).
Given no association with decreased patient or allograft survival, our findings suggest that pretransplant thyroid malignancy patients are unnecessarily subjected to increased wait-list duration before transplant. We recommend an individualized approach for pretransplant thyroid malignancy patients diagnosed before or after listing.
移植前恶性肿瘤与患者和移植物存活率降低有关。目前的美国指南建议在移植前进行 2 至 5 年的无肿瘤等待期。尚无大型研究检查过移植前甲状腺恶性肿瘤对肾移植后患者和移植物存活的具体现代风险。
检索 2003 年至 2019 年期间所有接受孤立性肾移植的成年患者的美国器官共享联合网络数据库。比较了移植前有甲状腺恶性肿瘤和无甲状腺恶性肿瘤的患者之间的患者特征、移植后恶性肿瘤发生率和存活率。
86 例患者在列出和进行肾移植前被诊断出患有移植前甲状腺恶性肿瘤。两组患者的总生存率和移植物生存率均相似（P>0.05）。在多变量分析中，甲状腺恶性肿瘤与患者（危险比：0.66；P=0.31）或移植物（危险比：0.32；P=0.11）生存率之间没有显著关联。移植前甲状腺恶性肿瘤患者的候补名单等待时间明显延长（1444 天 vs 438 天；P<0.01），这转化为透析时间延长（2234 天 vs 1201 天，P<0.01）。移植前甲状腺恶性肿瘤患者并未经历更高的移植后恶性肿瘤发生率（P=0.21）。
由于与患者或移植物存活率降低无关，我们的发现表明，移植前甲状腺恶性肿瘤患者不必要地在移植前接受更长的候补名单等待时间。我们建议对列出前后被诊断出患有移植前甲状腺恶性肿瘤的患者采取个体化方法。
