General, Emergency and Transplant Surgery Department, ASST-Sette Laghi and University of Insubria, Varese, Italy.
Department of General Surgery, Humanitas Clinical and Research Center, Milan, Italy.
World J Surg Oncol. 2023 Jan 23;21(1):18. doi: 10.1186/s12957-023-02892-3.
One of the main causes of post-transplant-associated morbidity and mortality is cancer. The aims of the project were to study the neoplastic risk within the kidney transplant population and identify the determinants of this risk. A cohort of 462 renal transplant patients from 2010 to 2020 was considered. The expected incidence rates of post-transplant cancer development in the referenced population, the standardized incidence ratios (SIR) taking the Italian population as a comparison, and the absolute risk and the attributable fraction were extrapolated from these cohorts of patients. Kidney transplant recipients had an overall cancer risk of approximately three times that of the local population (SIR 2.8). A significantly increased number of cases were observed for Kaposi's sarcoma (KS) (SIR 195) and hematological cancers (SIR 6.8). In the first 3 years post-transplant, the risk to develop either KS or hematological cancers was four times higher than in the following years; in all cases of KS, the diagnosis was within 2 years from the transplant. Post-transplant immunosuppression represents the cause of 99% of cases of KS and 85% of cases of lymphomas, while only 39% is represented by solid tumors. Data related to the incidence, the percentages attributable to post-transplant immunosuppression, and the time of onset of neoplasms, particularly for KS and hematological tumors could help improve the management for the follow-up in these patients.
移植后相关发病率和死亡率的主要原因之一是癌症。本项目旨在研究肾移植人群的肿瘤风险,并确定这种风险的决定因素。研究考虑了 2010 年至 2020 年期间的 462 名肾移植患者队列。从这些患者队列中推断出参考人群中移植后癌症发展的预期发生率、以意大利人群为比较的标准化发病比 (SIR),以及绝对风险和归因分数。肾移植受者的总体癌症风险约为当地人群的三倍 (SIR 2.8)。观察到卡波西肉瘤 (KS) (SIR 195) 和血液系统癌症的病例数显著增加 (SIR 6.8)。在移植后 3 年内,发生 KS 或血液系统癌症的风险比随后几年高四倍;所有 KS 病例的诊断均在移植后 2 年内。移植后免疫抑制是 99%的 KS 和 85%的淋巴瘤病例的原因,而实体瘤仅占 39%。与发病率、归因于移植后免疫抑制的百分比以及肿瘤发病时间相关的数据,特别是对于 KS 和血液系统肿瘤,可能有助于改善这些患者的随访管理。