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[恶性肿瘤与移植]

[Malignant neoplasms and transplantation].

作者信息

von Vietinghoff Sibylle, Manekeller Steffen, Fechner Guido, Brossart Peter, Kalff Jörg, Ritter Manuel, Strassburg Christian P

机构信息

Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn und Universität Bonn, Venusberg Campus 1, Gebäude 27, 53127, Bonn, Deutschland.

Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn und Universität Bonn, Bonn, Deutschland.

出版信息

Inn Med (Heidelb). 2025 Sep;66(9):896-902. doi: 10.1007/s00108-025-01960-y. Epub 2025 Jul 29.

DOI:10.1007/s00108-025-01960-y
PMID:40728537
Abstract

Malignant neoplasms constitute a major burden of morbidity and mortality in the general population. This necessitates intense screening of transplant candidates and even closer surveillance of immunosuppressed solid organ recipients. Active malignancy is an exclusion criterion to solid organ transplantation, with few exceptions, namely localized hepatic neoplasms. Accelerated tumor progression characterizes post-transplantation malignancies. Intensified surveillance is justified in elevated rates, e.g., of skin cancer and virus-associated neoplasms, especially Epstein-Barr virus-associated post-transplantation lymphoproliferative disease (PTLD). Renal cell cancer rates rise after kidney transplantation, predominantly affecting the native kidneys. Chemotherapeutic dose adjustments for renal and hepatic function pharmacokinetic interactions are frequent and require active monitoring. Immunotherapies pose new challenges by induction of allograft rejection. Data on management of immunosuppression are emerging. Individualized concepts need to take into account therapeutic options of both anti-cancer therapy and organ replacement.

摘要

恶性肿瘤是普通人群发病和死亡的主要负担。这就需要对移植候选者进行严格筛查,对接受免疫抑制的实体器官受者进行更密切的监测。除少数例外情况,即局限性肝脏肿瘤,活动性恶性肿瘤是实体器官移植的排除标准。移植后恶性肿瘤的特征是肿瘤进展加速。对于皮肤癌和病毒相关肿瘤,尤其是爱泼斯坦-巴尔病毒相关的移植后淋巴组织增生性疾病(PTLD)等发病率升高的情况,加强监测是合理的。肾移植后肾癌发病率上升,主要影响原肾。由于肾和肝功能的药代动力学相互作用,化疗剂量调整频繁,需要积极监测。免疫疗法通过诱导同种异体移植排斥反应带来了新的挑战。关于免疫抑制管理的数据正在不断涌现。个体化概念需要考虑抗癌治疗和器官替代的治疗选择。

相似文献

1
[Malignant neoplasms and transplantation].[恶性肿瘤与移植]
Inn Med (Heidelb). 2025 Sep;66(9):896-902. doi: 10.1007/s00108-025-01960-y. Epub 2025 Jul 29.
2
Immunosuppressive therapy and malignancy in organ transplant recipients: a systematic review.器官移植受者的免疫抑制治疗与恶性肿瘤:一项系统综述
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Virol J. 2025 Jan 15;22(1):11. doi: 10.1186/s12985-025-02623-y.
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Belatacept for kidney transplant recipients.用于肾移植受者的贝拉西普。
Cochrane Database Syst Rev. 2014 Nov 24;2014(11):CD010699. doi: 10.1002/14651858.CD010699.pub2.
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Polyclonal and monoclonal antibodies for induction therapy in kidney transplant recipients.用于肾移植受者诱导治疗的多克隆抗体和单克隆抗体。
Cochrane Database Syst Rev. 2017 Jan 11;1(1):CD004759. doi: 10.1002/14651858.CD004759.pub2.
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Synbiotics, prebiotics and probiotics for solid organ transplant recipients.固体器官移植受者的共生元、益生元和益生菌。
Cochrane Database Syst Rev. 2022 Sep 20;9(9):CD014804. doi: 10.1002/14651858.CD014804.pub2.
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Transplant Cell Ther. 2024 Jan;30(1):73.e1-73.e12. doi: 10.1016/j.jtct.2023.05.018. Epub 2023 Jun 4.
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Immunosuppressive T-cell antibody induction for heart transplant recipients.心脏移植受者的免疫抑制性T细胞抗体诱导治疗
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Antibody induction therapy for lung transplant recipients.肺移植受者的抗体诱导治疗。
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10
Epstein-Barr virus-associated post-transplant lymphoproliferative disorders in pediatric transplantation: A prospective multicenter study in the United States.儿童移植后与 Epstein-Barr 病毒相关的淋巴组织增生性疾病:美国的一项前瞻性多中心研究。
Pediatr Transplant. 2024 Jun;28(4):e14763. doi: 10.1111/petr.14763.

本文引用的文献

1
Diagnosis and management of immune checkpoint inhibitor-associated nephrotoxicity: a position statement from the American Society of Onco-nephrology.免疫检查点抑制剂相关肾毒性的诊断与管理:美国肿瘤肾脏病学会立场声明
Kidney Int. 2025 Jan;107(1):21-32. doi: 10.1016/j.kint.2024.09.017. Epub 2024 Oct 24.
2
Androgen receptor pathway inhibitors and drug-drug interactions in prostate cancer.雄激素受体通路抑制剂与前列腺癌的药物相互作用。
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The association between hydrochlorothiazide use and non-melanoma skin cancer in kidney transplant recipients.肾移植受者使用氢氯噻嗪与非黑色素瘤皮肤癌之间的关联。
Clin Kidney J. 2024 Apr 25;17(5):sfae126. doi: 10.1093/ckj/sfae126. eCollection 2024 May.
5
Cancer Surveillance in Solid Organ Transplant Recipients With a Pretransplant History of Malignancy: Multidisciplinary Collaborative Expert Opinion.有移植前恶性肿瘤病史的实体器官移植受者的癌症监测:多学科协作专家意见
Transplantation. 2024 Dec 1;108(12):2336-2350. doi: 10.1097/TP.0000000000005056. Epub 2024 May 21.
6
Fine-tuning tumor- and allo-immunity: advances in the use of immune checkpoint inhibitors in kidney transplant recipients.微调肿瘤免疫和同种异体免疫:肾移植受者使用免疫检查点抑制剂的进展
Clin Kidney J. 2024 Mar 9;17(4):sfae061. doi: 10.1093/ckj/sfae061. eCollection 2024 Apr.
7
Immune Checkpoint Inhibitors in Recipients of Renal Allografts.肾移植受者中的免疫检查点抑制剂
Semin Nephrol. 2024 Jan;44(1):151500. doi: 10.1016/j.semnephrol.2024.151500. Epub 2024 Mar 27.
8
Skin Cancer and Hydrochlorothiazide: Novel Population-Based Analyses Considering Personal Risk Factors Including Race/Ethnicity.皮肤癌与氢氯噻嗪:考虑种族/民族等个人风险因素的新型基于人群的分析。
Hypertension. 2023 Oct;80(10):2218-2225. doi: 10.1161/HYPERTENSIONAHA.123.21274. Epub 2023 Jul 25.
9
Immune checkpoint blockade for organ-transplant recipients with cancer: A review.癌症器官移植受者的免疫检查点阻断:综述。
Eur J Cancer. 2022 Nov;175:326-335. doi: 10.1016/j.ejca.2022.08.010. Epub 2022 Sep 30.
10
Malignancies in adult kidney transplant candidates and recipients: current status.成人肾移植候选人和受者的恶性肿瘤:现状。
Nephrol Dial Transplant. 2023 Jun 30;38(7):1591-1602. doi: 10.1093/ndt/gfac239.