Herreros J, Flórez S, Echevarría J R, Fernández A L, Pardo Mindán F J
Servicio de Cirugía Cardíaca, Hospital Universitario, Valladolid.
Rev Esp Cardiol. 1995;48 Suppl 7:129-34.
According to the Spanish Cardiac Transplantation Registry, malignant neoplasm remain the fifth leading cause of death in heart transplant recipients. Skin cancers are the most common malignancies and they are frequently associated to solar keratosis, warts and keratoacanthoma. Geographic areas are high cumulative ultraviolet exposure have a greater incidence of skin cancer. Skin tumors are often located in chronically sun-exposed areas of the body. Lymphoproliferative disorders are the second most frequent malignant neoplasm after heart transplantation. Incidence of lymphoma is 350 times greater in heart transplant recipients than in the general population. B-cell tumors are the most common histologic type and it is associated with infection by the Epstein-Barr virus. T-cell tumors account for a 12% of all lymphoproliferative diseases and are not related to viral infections. Kaposi's sarcoma is the thirth commonest neoplasm in heart transplant recipients. Other malignat tumors are: uterine cervix, vulva, scrotum, colon, stomach, kidney and biliary tract. Prevention of neoplasm in heart transplant recipients include a decrease of immunosuppression and the avoidance of multiple immunosuppressive drug association. Some cases of neoplasm regression have been described when immunosuppressive therapy is decreased.
根据西班牙心脏移植登记处的数据,恶性肿瘤仍然是心脏移植受者的第五大死因。皮肤癌是最常见的恶性肿瘤,它们常与日光性角化病、疣和角化棘皮瘤相关。紫外线累积暴露量高的地理区域皮肤癌发病率更高。皮肤肿瘤常位于身体长期暴露于阳光下的部位。淋巴增殖性疾病是心脏移植后第二常见的恶性肿瘤。心脏移植受者患淋巴瘤的几率比普通人群高350倍。B细胞肿瘤是最常见的组织学类型,它与爱泼斯坦-巴尔病毒感染有关。T细胞肿瘤占所有淋巴增殖性疾病的12%,与病毒感染无关。卡波西肉瘤是心脏移植受者中第三常见的肿瘤。其他恶性肿瘤包括:子宫颈、外阴、阴囊、结肠、胃、肾脏和胆道。心脏移植受者肿瘤的预防包括减少免疫抑制以及避免联合使用多种免疫抑制药物。当免疫抑制治疗减少时,已有一些肿瘤消退的病例报道。