免疫抑制剂对肾移植受者术后并发恶性肿瘤的影响

Effect of immunosuppressants on incidence of malignant tumors following kidney transplantation

目的观察肾移植术后恶性肿瘤的发生情况及免疫抑制剂对其发生的影响。方法回顾性分析1996年1月至2006年12月在济南军区总医院进行同种异体肾移植的852例受者中39例发生恶性肿瘤患者的临床资料,将其分为硫唑嘌呤(AZA)组(n=12)和吗替麦考酚酯(MMF)组(n=27),应用Kaplan-Meier法估计并绘制两组生存曲线,用log-rank法比较两组生存率,分析免疫抑制剂对并发恶性肿瘤患者生存的影响。结果 852例肾移植受者术后恶性肿瘤总发生率为4.6%(39/852),其中泌尿系统肿瘤占74.4%(29/39)、消化系统肿瘤占15.4%(6/39)、肺癌占7.7%(3/39)、皮肤癌占2.5%(1/39)。3年无病生存率AZA组为83.1%,MMF组为81.1%;平均生存时间AZA组为(64±8)个月,MMF组为(53±4)个月;两组3年无病生存率及平均生存时间比较差异均无统计学意义(P=0.16,P=0.61)。使用两种不同免疫抑制剂的肾移植术后并发恶性肿瘤患者的病死率差异无统计学意义(χ2=0.075,P>0.05)。结论肾移植术后并发恶性肿瘤仍以泌尿系统肿瘤为主。AZA与MMF两种免疫抑制剂对肾移植术后并发恶性肿瘤的影响没有明显区别。

Objective To study the incidence of malignant tumors following kidney transplantation and the role of immunosuppressants in it.Methods The clinical data of 852 renal transplant recipients in General Hospital of Jinan Military Command from January 1996 to December 2006 were retrospectively analyzed,among which 39 recipients of malignant tumors were collected.The 39 recipients were then divided into azathioprine（AZA） group（n=12） and mycophenolate mofetil（MMF） group（n=27）.The survival curves of the two groups were described by the Kaplan-Meier method.The survival rate and time of the two groups were compared.Results The incidence of malignant tumors following kidney transplantation was 4.6%（39/852）.The malignant tumors compromised 74.4% urinary system tumors（29/39）,15.4% carcinomas of digestive system（6/39）,7.7% pulmonary carcinomas（3/39）,and 2.5% cutaneous cancer（1/39）.The 3-year disease-free survival rates of AZA and MMF groups were 83.1% and 81.1%,respectively;and the median survivals of AZA group and MMF group were（64±9） and（53±4） months,respectively.No statistically significant difference in the 3-year disease-free survival and the average survival time was noted between the two groups（P=0.16,P=0.61）.The mortality of the two groups did not significantly differ（χ2=0.075,P〉0.05）.Conclusion Malignant tumors following kidney transplantation are still mainly from urinary system.AZA and MMF had no effect on the incidence of these tumors.