肾移植患者恶性肿瘤发病特征和危险因素

Characteristics and risk factors of malignant tumor in kidney transplantation recipients

背景与目的:肾移植患者较一般人群易发生恶性肿瘤,且发病特征发生了根本的改变。本研究主要分析肾移植术后患者恶性肿瘤发病特征并探讨影响肿瘤发生的危险因素。方法:回顾性分析我院1991年1月至2007年8月2 392例肾移植患者中发生的31例患者的恶性肿瘤类型、肾移植时年龄、术后至肿瘤诊断时时间、免疫抑制剂应用情况进行分组比较和相关性分析。结果:肾抑制受者恶性肿瘤发生率为1.29%,以消化道肿瘤为主(35.5%)。恶性肿瘤发生率与肾移植时年龄正相关、与男性性别相关。免疫诱导组在恶性肿瘤诊断时肾功能不全发生率较非免疫诱导组明显降低,但肾移植术后至肿瘤诊断时间明显缩短,且患者1年生存率无明显改善。结论:肾移植受者恶性肿瘤发生率高于一般人群,肿瘤类型以肝癌、甲状腺癌和非何杰金淋巴瘤为主;免疫诱导、肾移植时年龄、男性是发生恶性肿瘤的危险因素。肾移植术后患者应进行个体化免疫抑制治疗,早期发现并诊断肿瘤,积极进行以根治性手术为主的综合治疗。

Background and purpose：The kidney transplant recipient has higher risk to develop malignant tumor than the general population,and the charatceristics of malignant tumor had radically changed.This study was designed to analyze the characteristics of malignant tumor and investigate the risk factors in kidney transplant recipients.Methods：The clinical data of 2392 kidney transplant cases in our hospital between Jan.1991 and Aug.2007 were retrospectively analyzed on the type of malignant tumor,the age of recipient at kidney transplantation,the time interval between transplantation and tumor detection,the type of immunosuppressant after kidney transplantation,then was compared by group and analyzed on the correlativity.Results：The incidence of malignant tumor was 1.29% in kidney transplantation recipients,and it was positively correlated with the age of recipients at kidney transplantation and male gender respectively.Malignant tumors in digestive system were the most common type（35.5%）.The incidence of the renal dysfunction in the recipient who were induced by ALG/Zenapax was significantly lower than that of the non-induced recipient,but the time interval between trans-plantation and tumor detection was significantly shorter,and 1-year survival rate was not obviously improved.Conclusions：The incidence of malignant tumor in kidney transplant recipients was higher than general population.Their main malignancies were hepatic cancer,thyroid carcinoma and non-Hodgkin＇s lymphoma.Induced by ALG/Daclizumab,the age of recipients at kidney transplantation and male gender were risk factors of developing malignant tumor.The kidney transplant recipient should be treated with immmunosuppressant individually and early diagnosed.Complex therapy based on radical surgery should be carried out early.