Department of Translational Medical Sciences, University of Campania 'L. Vanvitelli', Naples, Italy.
Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
J Nephrol. 2024 Jul;37(6):1611-1619. doi: 10.1007/s40620-024-01951-6. Epub 2024 Jun 4.
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare disease with limited data on outcomes after transplantation.
In this single-center retrospective cohort study, we describe the outcomes of kidney transplant patients with AAV transplanted at our institute from February 2006 to January 2022.
We identified 9 patients among 1026 with a pre-transplant diagnosis of AAV; all patients had received previous treatment with cyclophosphamide. Maintenance immunosuppression after transplantation was tacrolimus-based in 89% of the patients. At the end of a mean follow-up of 132 ± 61.1 months after transplantation, only one case of extrarenal vasculitis relapse was observed. The relapse rate was 0.01 per patient per year, which is comparable to that reported in the literature. However, seven patients were diagnosed with cancer after a mean follow-up of 81.4 months after transplantation; six had skin cancer and three had renal cell carcinoma (RCC) of the native kidneys (cumulative incidence of 78%). One patient died from metastatic squamous cell carcinoma.
In this study, we found a noticeable decrease in disease relapse (1 relapse in the present cohort vs 7 relapses in 19 patients in the previous cohort) in kidney transplant patients with AAV compared with previous data from our group (December 1987-January 2006). Conversely, we found a high incidence of post-transplant cancer. This result could be attributed to reduced immunosurveillance due to immunosuppression therapy before and after transplantation. Therefore, constant cancer early diagnosis and prevention is mandatory during the post-transplant follow-up of AAV patients.
抗中性粒细胞胞质抗体（ANCA）相关性血管炎（AAV）是一种罕见疾病，关于移植后结局的数据有限。
在这项单中心回顾性队列研究中，我们描述了 2006 年 2 月至 2022 年 1 月期间在我院接受 AAV 移植的肾移植患者的结局。
我们在 1026 例患者中发现了 9 例在移植前诊断为 AAV 的患者；所有患者均接受过环磷酰胺治疗。89%的患者在移植后接受他克莫司为基础的维持免疫抑制治疗。在移植后平均 132±61.1 个月的随访结束时，仅观察到 1 例肾外血管炎复发。复发率为每年 0.01 例/患者，与文献报道的相似。然而，7 例患者在移植后平均 81.4 个月后被诊断为癌症；6 例患有皮肤癌，3 例患有原肾肾细胞癌（RCC）（累积发生率为 78%）。1 例患者死于转移性鳞状细胞癌。
在这项研究中，我们发现与我们小组之前的数据（1987 年 12 月至 2006 年 1 月）相比，AAV 肾移植患者的疾病复发率（本队列中有 1 例复发，而前一队列中有 19 例患者中有 7 例复发）明显降低。相反，我们发现移植后癌症的发病率很高。这一结果可能归因于移植前后免疫抑制治疗导致的免疫监视减少。因此，在 AAV 患者的移植后随访期间，必须进行持续的癌症早期诊断和预防。
