肾移植受者的恶性肿瘤患病率高于血液透析患者。
Kidney Transplant Recipients Have Higher Malignancy Prevalence Than Hemodialyzed Patients.
机构信息
Department of Nephrology, Dialysis and Internal Disease, Medical University of Warsaw, Warsaw, Poland.
First Department of Nephrology and Transplantology, Medical University of Bialystok, Białystok, Poland.
出版信息
Transplant Proc. 2022 May;54(4):972-975. doi: 10.1016/j.transproceed.2022.01.018. Epub 2022 Mar 10.
BACKGROUND
Kidney transplant is the preferred therapy for end-stage kidney disease; however, it has been associated with some serious complications, including malignancy, which became the second leading cause of death among kidney allograft recipients. The aim of this study was to assess the prevalence of malignancy in hemodialyzed patients and in kidney transplant recipients.
METHODS
A cross-sectional study was conducted in 114 prevalent hemodialyzed patients, including 7 on the waiting list and 350 kidney allograft recipients. Hemodialyzed patients and kidney allograft recipients did not differ in regard to sex, dialysis vintage, and cause of end-stage renal failure, but were significantly older.
RESULTS
Among wait-listed patients, only 1 had a history of malignancy (gastric cancer stage G1). Among kidney allograft recipients, in 70 patients, malignancy developed (in total 20% of the studied population). The leading malignancy was skin cancer (18 cases), followed by post-transplant lymphoproliferative disorder (PTLD) in 10 cases, lung cancer (small cell and non-small cell lung cancer; 4 cases), renal cell carcinoma (3 cases), brain cancer (glioma; 3 cases), colorectal cancer (3 cases), Kaposi sarcoma (2 cases), Merkel carcinoma (2 cases), metastatic disease of unknown origin (2 cases), and other 23 malignancies were in a single patient (including 1 leukemia and 1 multiple myeloma). Twenty-six deaths were recorded in kidney allograft recipients with malignancy, mainly in PTLD, Kaposi sarcoma, Merkel carcinoma, sarcoma, glioma, and melanoma.
CONCLUSIONS
Despite the lower prevalence of malignancy on hemodialyzed population, cancer screening in both potential transplant recipients and kidney allograft recipients is a prerequisite, because nowadays there is a scarcity of data in this area. It may be due to previous immunosuppression, long-term dialysis vintage, immunocompromised status, and immunosuppressive therapy after transplant, in particular in high-risk patients.
背景
肾移植是治疗终末期肾病的首选疗法；然而，它与一些严重的并发症有关，包括恶性肿瘤，这已成为肾移植受者死亡的第二大原因。本研究旨在评估血液透析患者和肾移植受者恶性肿瘤的患病率。
方法
对 114 例现患血液透析患者（包括 7 例等待移植患者和 350 例肾移植受者）进行了横断面研究。血液透析患者和肾移植受者在性别、透析龄和终末期肾衰竭病因方面无差异，但年龄明显较大。
结果
在等待移植的患者中，仅有 1 例有恶性肿瘤（胃癌 G1 期）病史。在肾移植受者中，70 例患者发生了恶性肿瘤（占研究人群的 20%）。主要的恶性肿瘤是皮肤癌（18 例），其次是移植后淋巴组织增生性疾病（PTLD）10 例，肺癌（小细胞肺癌和非小细胞肺癌；4 例），肾细胞癌（3 例），脑癌（神经胶质瘤；3 例），结直肠癌（3 例），卡波西肉瘤（2 例），默克尔细胞癌（2 例），不明来源的转移性疾病（2 例），另外 23 例恶性肿瘤为单例（包括 1 例白血病和 1 例多发性骨髓瘤）。在有恶性肿瘤的肾移植受者中记录了 26 例死亡，主要发生在 PTLD、卡波西肉瘤、默克尔细胞癌、肉瘤、神经胶质瘤和黑色素瘤。
结论
尽管血液透析人群恶性肿瘤的患病率较低，但对潜在的移植受者和肾移植受者进行癌症筛查是必要的，因为目前这方面的数据较少。这可能是由于先前的免疫抑制、长期透析龄、免疫功能低下状态和移植后的免疫抑制治疗，特别是在高危患者中。
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