肾移植术后并发恶性肿瘤15例分析

Analysis of 15 cases of Malignant Tumors after Renal Transplantation

目的分析肾移植术后恶性肿瘤的发病情况、类型、治疗及预后。方法回顾性分析1983至2003年同种肾移植术1058例次,术后免疫抑制剂使用情况和恶性肿瘤的发生情况。结果共发现恶性肿瘤15例,发生率1.41%,分别发生于移植术后13至141个月,平均47个月。其中泌尿系肿瘤11例,肺癌1例,脑膜癌1例,胃癌、肝癌各1例。所有患者确诊后减少免疫抑制剂的剂量,同期环孢素减少1/2,骁悉或硫唑嘌呤停用或减少1/2量。11例行手术治疗,未行特殊治疗4例。现存活3例,平均存活20个月,10例属肿瘤晚期,短期内死亡,另外1例死于呼吸衰竭,1例死于肝功能衰竭。结论肾移植术后恶性肿瘤的发生率明显增高,以泌尿系肿瘤最常见,治疗上应争取尽早手术切除肿瘤,并应及时调整免疫抑制剂的应用剂量。

Objective To analyze the incidence,type and prognosis of malignant tumors in renal transplantation cases.Methods From 1983 to 2003,the data of 1058 renal transplantation cases were collected and the use of immunosuppressive agents and the incidence of malignant tumors were retrospectively analyzed.Results A total of 15 cases of malignant tumors were confirmed.The incidence of malignant tumor after renal transplantation was 1.41%.They occurred in 13 -141 months(47 months in average) postoperatively,which contained 11 cases of urinary system cancer,1 case of lung cancer,1 case of meningeal cancer,1 case of Gastric cancer and 1 case of liver cancer.When the malignant tumor diagnosis were confirmed,the dosage of cyclosporine were reduced to 1/2 and the mycophenolate mofetil or azathioprine were stopped or reduce to 1/2 dosage.In all these malignant tumors,11 cases underwent surgical treatments,and 4 cases were followed up without surgery.10 cases died in a short time,because of the advanced cancer.1 patient died from respiratory failure,1 patient died from liver failure,and 3 cases survived until now.The average survival time were 20 months.Conclusions After renal transplantation,the incidence of malignant tumors increased significantly and urinary system tumor was the most common type.Surgical ivswlion was highly recommended,and the application of immunosuppressant dosage should be adjusted promptly.