Zhang He, Hu Xiaopeng
Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gongti South Road, Beijing, 100020, China.
Institute of Urology, Capital Medical University, Beijing, 100020, China.
World J Urol. 2024 Dec 2;43(1):5. doi: 10.1007/s00345-024-05376-5.
Kidney transplantation is the optimal therapy for end-stage renal disease, but pre-transplant malignancy (PTM) is a concern due to the increased risk of cancer recurrence with immunosuppression. While advancements in immunosuppression and cancer treatments have improved kidney recipient and graft survival, the impact of PTM on survival remains unclear and warrants comprehensive assessment.
This systematic review and meta-analysis followed PRISMA guidelines. Relevant studies were identified through searches in PubMed, EMBASE, and Cochrane Library from inception to 1st May 2024 for outcomes including all-cause mortality, cancer-specific mortality, graft survival, death-censored graft survival, and de novo malignancy.
Eighteen studies were included in meta-analyses for various outcomes. Kidney transplant recipients with PTM had significantly higher all-cause mortality {hazard ratio [HR] = 1.45 [95% confidence interval (CI) 1.19-1.78]}, cancer-specific mortality [HR = 2.66 (95% CI 1.50-4.72)], risk of post-transplant de novo malignancy [HR = 1.66 (95% CI 1.22-2.25)] and worse graft survival [HR = 1.13 (95% CI 1.05-1.21)] compared to those without PTM. However, there was no significant difference in death-censored graft survival [HR = 1.09 (95% CI 0.82-1.45)].
Kidney transplant recipients with PTM experienced an increased risk of all-cause mortality, cancer-specific mortality, graft loss, and post-transplant de novo malignancy compared to those without PTM. Careful assessment, focused screening, and tailored management protocols are necessary for this high-risk group of patients.
肾移植是终末期肾病的最佳治疗方法，但由于免疫抑制会增加癌症复发风险，移植前恶性肿瘤（PTM）成为一个令人担忧的问题。尽管免疫抑制和癌症治疗方面的进展提高了肾移植受者的生存率和移植物存活率，但PTM对生存的影响仍不明确，需要进行全面评估。
本系统评价和荟萃分析遵循PRISMA指南。通过检索PubMed、EMBASE和Cochrane图书馆，从创刊至2024年5月1日，确定相关研究，以获取包括全因死亡率、癌症特异性死亡率、移植物存活率、死亡删失移植物存活率和新发恶性肿瘤等结局。
18项研究纳入了各种结局的荟萃分析。与没有PTM的肾移植受者相比，有PTM的受者全因死亡率显著更高{风险比[HR]=1.45[95%置信区间（CI）1.19-1.78]}，癌症特异性死亡率[HR=2.66（95%CI 1.50-4.72）]，移植后新发恶性肿瘤风险[HR=1.66（95%CI 1.22-2.25）]，移植物存活率更差[HR=1.13（95%CI 1.05-1.21）]。然而，死亡删失移植物存活率没有显著差异[HR=1.09（95%CI 0.82-1.45）]。
与没有PTM的肾移植受者相比，有PTM的受者全因死亡率、癌症特异性死亡率、移植物丢失和移植后新发恶性肿瘤的风险增加。对于这一高危患者群体，需要进行仔细评估、重点筛查和量身定制的管理方案。
