von Vietinghoff Sibylle, Manekeller Steffen, Fechner Guido, Brossart Peter, Kalff Jörg, Ritter Manuel, Strassburg Christian P
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.
Inn Med (Heidelb). 2025 Sep;66(9):896-902. doi: 10.1007/s00108-025-01960-y. Epub 2025 Jul 29.
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.
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。