Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
Department of Bigdata and Bioinformatics, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
BMC Nephrol. 2022 Apr 28;23(1):160. doi: 10.1186/s12882-022-02796-6.
Post-transplant malignancy is major morbidity complicated in kidney transplantation (KT). In Korea, a few studies have investigated the sex- and age-dependent risk for post-transplant malignancy among KT recipients on a large scale.
We utilized a national health insurance database in Korea to investigate the relative risk of post-transplant malignancy in 12,634 KT recipients between 2007 and 2017. The same number of patients with acute appendicitis was included as a control group. The relative risk of malignancy was estimated using a multivariable-adjusted Cox model, and interaction analysis was performed to investigate age- and sex-predominant patterns.
KT recipients had an overall 1.8-fold higher risk for post-transplant malignancy with an increased risk for 14 of 29 cancer types, among which Kaposi's sarcoma, non-Hodgkin's lymphoma, kidney, uterus, and bladder/urinary tract cancers were most prominent. Although the overall risk for post-transplant malignancy was similar between male and female KT recipients, head and neck cancer had a higher risk among male KT recipients, whereas non-Hodgkin's lymphoma and bladder/urinary tract cancer had a higher risk among female KT recipients. Overall, the young (< 50 years) KT recipients had a higher risk for post-transplant malignancy than older ones (≥ 50 years), whose pattern was most prominent in non-Hodgkin's lymphoma. In contrast, breast and nonmelanoma skin cancer showed a higher risk among older KT recipients.
KT recipients had an increased risk for a wide range of cancer types, some of which showed differential risk patterns with age and sex. Our result suggests that focused screening for predominant post-transplant malignancies may be an effective strategy for selected KT recipients.
移植后恶性肿瘤是肾脏移植（KT）中常见的严重并发症。在韩国，少数研究大规模调查了 KT 受者的性别和年龄依赖性移植后恶性肿瘤风险。
我们利用韩国国家健康保险数据库，调查了 2007 年至 2017 年间 12634 名 KT 受者的移植后恶性肿瘤的相对风险。作为对照组，纳入了相同数量的急性阑尾炎患者。使用多变量调整 Cox 模型估计恶性肿瘤的相对风险，并进行交互分析以研究年龄和性别占主导地位的模式。
KT 受者的移植后恶性肿瘤总体风险增加了 1.8 倍，29 种癌症类型中有 14 种的风险增加，其中卡波西肉瘤、非霍奇金淋巴瘤、肾脏、子宫和膀胱/尿路癌症最为突出。尽管男性和女性 KT 受者的移植后恶性肿瘤总体风险相似，但男性 KT 受者的头颈部癌症风险较高，而女性 KT 受者的非霍奇金淋巴瘤和膀胱/尿路癌症风险较高。总体而言，年轻（<50 岁）的 KT 受者的移植后恶性肿瘤风险高于年长（≥50 岁）的 KT 受者，这种模式在非霍奇金淋巴瘤中最为明显。相比之下，老年 KT 受者的乳腺癌和非黑素瘤皮肤癌风险较高。
KT 受者发生多种癌症的风险增加，其中一些癌症的风险模式与年龄和性别存在差异。我们的结果表明，针对主要移植后恶性肿瘤进行有针对性的筛查可能是 KT 受者的有效策略。
