Demir Erol, Dincer Mevlut Tamer, Karaca Cebrail, Erel Cansu, Karahan Latif, Pekmezci Aslihan, Trabulus Sinan, Seyahi Nurhan, Turkmen Aydin
Transplant Immunology Research Center of Excellence, Koç University Hospital, Koç University, Istanbul, Türkiye.
Division of Nephrology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University Cerrahpaşa, Istanbul, Türkiye.
Clin Kidney J. 2024 Nov 19;17(12):sfae349. doi: 10.1093/ckj/sfae349. eCollection 2024 Dec.
Malignancies are the third leading cause of death among kidney transplant recipients. These patients face increased mortality and challenges such as allograft loss and rejection, which may arise from surgical complications, changes in immunosuppressive therapy or the use of chemotherapeutics. This study aims to examine the risk of allograft rejection and loss in kidney transplant recipients diagnosed with malignancies.
This retrospective case-control study included adult kidney transplant patients from 1986 to 2020 who developed malignancies. Each patient with a malignancy was matched with a control without malignancy using the nearest neighbor matching method. The outcomes measured were biopsy-confirmed allograft rejection, death-censored allograft loss and overall mortality after the diagnosis of malignancy in the malignancy group and at any point in the control group.
Of 2750 records reviewed, 267 patients (9.7%) had biopsy-confirmed malignancies, with a median age of 60 years and 66.3% men. The median follow-up was 218 months. Kaplan-Meier analysis showed that the allograft rejection rates were lower in the malignancy group compared with the control group (26 vs 60, < .001). Overall mortality was higher in the malignancy group, although this difference was not statistically significant (104 vs 73, = .25). Death-censored allograft loss was similar between groups (22 vs 32, = .49). Chemotherapy and older recipient age were associated with reduced allograft rejection risk, as indicated by multivariable regression analysis.
In kidney transplant recipients with malignancies, death with a functioning graft remains significant. However, allograft loss rates do not increase compared with those without malignancies, and rejection risk is reduced, especially in older and chemotherapy-treated patients. These findings suggest that managing immunosuppression reduction in this population may be appropriate, but further research is needed to determine optimal care strategies.
恶性肿瘤是肾移植受者中第三大主要死因。这些患者面临更高的死亡率以及诸如移植肾丢失和排斥反应等挑战，这些情况可能源于手术并发症、免疫抑制治疗的改变或化疗药物的使用。本研究旨在探讨被诊断为恶性肿瘤的肾移植受者发生移植肾排斥和丢失的风险。
这项回顾性病例对照研究纳入了1986年至2020年间发生恶性肿瘤的成年肾移植患者。采用最近邻匹配法将每例患有恶性肿瘤的患者与未患恶性肿瘤的对照进行匹配。测量的结局指标为恶性肿瘤组在诊断恶性肿瘤后以及对照组在任何时间点的活检证实的移植肾排斥、死亡审查的移植肾丢失和总死亡率。
在审查的2750份记录中，267例患者（9.7%）有活检证实的恶性肿瘤，中位年龄为60岁，男性占66.3%。中位随访时间为218个月。Kaplan-Meier分析显示，恶性肿瘤组的移植肾排斥率低于对照组（26比60，<0.001）。恶性肿瘤组的总死亡率较高，尽管这一差异无统计学意义（104比73，P = 0.25）。两组间死亡审查的移植肾丢失情况相似（22比32，P = 0.49）。多变量回归分析表明，化疗和受者年龄较大与移植肾排斥风险降低有关。
在患有恶性肿瘤的肾移植受者中，移植肾有功能时死亡的情况仍然很显著。然而，与未患恶性肿瘤的患者相比，移植肾丢失率并未增加，且排斥风险降低，尤其是在年龄较大和接受化疗的患者中。这些发现表明，在该人群中调整免疫抑制可能是合适的，但需要进一步研究以确定最佳治疗策略。
