肾移植后恶性肿瘤16例:临床报告并文献复习

Sixteen cases of malignant tumor after renal transplantation:Clinical report and literature review

背景:肾移植后发生恶性肿瘤的原因是多方面的,其高发率与大剂量免疫抑制剂的长期应用密切相关。目的:回顾性分析肾移植后免疫抑制剂应用情况、恶性肿瘤发生率、移植后肿瘤发生时间,发病特征及其相关因素,探讨肿瘤与免疫抑制剂的相关性。方法:对512例肾移植中并发恶性肿瘤的16例患者的临床资料进行回顾性分析。15例患者肾移植后采用霉酚酸酯+环孢素A+甲泼尼龙三联预防排异反应,1例患者采用霉酚酸酯+硫唑嘌呤+甲泼尼龙。移植后肿瘤的治疗方法:手术12例,单纯化疗1例,因病情晚期出现多处转移或患者放弃治疗3例。结果与结论:肾移植后患者肿瘤发生率为3.13%,其中泌尿系肿瘤6例,占37.5%;消化道肿瘤4例(结肠癌2例,直肠癌、胃癌各1例),占25.0%;肝癌3例,占18.75%;皮肤癌、肺癌、卵巢癌各1例,各占6.25%。提示肾移植后患者最常见的恶性肿瘤为泌尿系肿瘤,其次为消化道肿瘤。对移植后患者,减少免疫抑制剂用量是防止移植后肿瘤发生、提高移植后患者长期存活率的主要因素之一。

BACKGROUND： There is multiple reasons for malignant tumor after the renal transplant, its high morbidity rate is closely related to the long term utilize of large dose of immunosuppressant. OBJECTIVE： To discusses the relativity between tumors and the immunosuppressant by retrospective analysis the utilize of immunosuppressant after renal transplantation, the morbidity rate of malignant tumor, the time of tumor occurrences and its characteristics, as well as other releted factors. METHODS： Sixteen patients with malignant tumors were selected from 512 renal transplant patients to perform the retrospective analysis. Fifteen patients were treated with mycophenolate mofetil＋cyclosporine A＋methylprednisolone, and one patient treated with mycophenolate mofetil＋azathioprine＋methylprednisolone. After renal transplantation, 12 patients were treated with surgery, one patient was treated with chemotherapy alone, and three patients had metastases in the advanced stage or gave up the treatment. RESULTS AND CONCLUSION： The tumor incidence rate of the patients after renal transplantation was 3.13%, among them, six cases with urinary tumors （37.5%）, four cases of gastrointestinal tumors （25.0%, two cases of colon cancer, one case of rectal cancer and one case of gastric cancer）, three cases of liver cancer （18.75%）, one case of lung cancer （6.25%）, one case of ovarian cancer （6.25%） and one case of skin cancer （6.25%）. Among the renal transplant patients, the most commonly malignant tumor is urinary tumor and followed by gastrointestinal tumor. For the renal transplant patients, reducing the dose of immunosuppressant is one of the primary key factors that can help to prevent the occurrences of tumor after the renal transplant and increase the long term survival rate of renal transplant patients.