Pośpiech Marta, Kolonko Aureliusz, Nieszporek Teresa, Kozak Sylwia, Kozaczka Anna, Karkoszka Henryk, Winder Mateusz, Chudek Jerzy
Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia in Katowice, Katowice 40-027, Poland.
Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice 40-027, Poland.
World J Clin Cases. 2022 Jul 6;10(19):6647-6655. doi: 10.12998/wjcc.v10.i19.6647.
The overall risk of malignancies in kidney transplant recipients (KTRs) is higher than that in the general population. It is associated with long-lasting exposure to immunosuppressive agents and impaired oncological vigilance due to chronic kidney disease. Colorectal cancer (CRC), frequently diagnosed in an advanced stage, is one of the most common malignancies in this cohort and is associated with poor prognosis. Still, because of the scarcity of data concerning adjuvant chemotherapy in this group, there are no clear guidelines for the specific management of the CRCs in KTRs. We present a patient who lost her transplanted kidney shortly after initiation of adjuvant chemotherapy for colon cancer.
A 36-year-old woman with a medical history of kidney transplantation (2005) because of end-stage kidney disease, secondary to chronic glomerular nephritis, and long-term immunosuppression was diagnosed with locally advanced pTNM (clinical stage III) colon adenocarcinoma G2. After right hemicolectomy, the patient was qualified to receive adjuvant chemotherapy that consisted of oxaliplatin, leucovorin and 5-fluorouracil (FOLFOX-4). The deterioration of kidney graft function after two cycles caused chemotherapy cessation and initiation of hemodialysis therapy after a few months. Shortly after that, the patient started palliative chemotherapy because of cancer recurrence with intraperitoneal spread.
Initiation of adjuvant chemotherapy for colon cancer increases the risk of rapid kidney graft loss driven also by under-immunosuppression.
肾移植受者（KTRs）发生恶性肿瘤的总体风险高于普通人群。这与长期暴露于免疫抑制剂以及慢性肾脏病导致的肿瘤监测功能受损有关。结直肠癌（CRC）在该队列中是最常见的恶性肿瘤之一，常被诊断为晚期，且预后较差。然而，由于该群体中关于辅助化疗的数据稀缺，对于KTRs中CRC的具体管理尚无明确指南。我们报告一例患者，其在结肠癌辅助化疗开始后不久移植肾丢失。
一名36岁女性，有肾移植病史（2005年），因慢性肾小球肾炎继发终末期肾病接受肾移植，长期接受免疫抑制治疗，被诊断为局部晚期pTNM（临床III期）G2级结肠腺癌。右半结肠切除术后，患者符合接受由奥沙利铂、亚叶酸钙和5-氟尿嘧啶组成的辅助化疗（FOLFOX-4）的条件。两个周期后移植肾功能恶化导致化疗停止，数月后开始血液透析治疗。此后不久，患者因癌症复发伴腹腔播散开始姑息化疗。
结肠癌辅助化疗的开始增加了因免疫抑制不足导致移植肾快速丢失的风险。
