原发性中枢神经系统肿瘤供者供肾移植63例安全性分析

Renal transplant from donors with primary central nervous system tumors： single center experience

目的 探讨原发性中枢神经系统（CNS）肿瘤供者供肾用于肾移植的安全性.方法 分析华中科技大学同济医学院附属同济医院2013年1月至2016年12月间的33例原发性CNS肿瘤供者的临床资料,以及相应的63例肾移植受者的随访资料.结果 33例供者从确诊原发性CNS肿瘤到捐献的时间为（21.8±46.4）个月（0.5～192.0个月）,病理分类包括胶质瘤21例,脑膜瘤1例,髓母细胞瘤2例;CNS肿瘤病理分级包括Ⅱ级肿瘤1例,Ⅲ级肿瘤6例及Ⅳ级肿瘤4例;有11例既往有开颅术、V-P/V-A分流术、放射治疗、化学治疗等肿瘤相关治疗史,14例无任何肿瘤相关治疗史;其余供者资料不详.受者63例的移植肾功能均恢复良好,随访（15.9±8.2）个月（2.7～35.5个月）,除1例子术后4个月出现供者来源的横纹样肿瘤外,余62例均未发现肿瘤转移.结论 原发性CNS肿瘤供者供肾移植存在供者来源的肿瘤转移风险,但发生率较低.术前应充分评估肿瘤病理类型及治疗史,平衡移植等待死亡与肿瘤转移的风险,慎重选择利用,并保证患者知情同意.

Objective To analyze the safety of renal transplant from donors with primary central nervous system （CNS） tumors.Methods We retrospectively analyzed the clinical data of 33 donors with primary CNS tumors and the 63 corresponding renal recipients between January 2013 and December 2016 in Tongji Hospital.Results The mean period from diagnosis as primary CNS tumor to donation was about （21.8± 46.4） months （range：0.5 to 192.0 months）.The pathological classification of these tumors included gliomas,meningioma,medulloblastoma,etc.Besides,there were 10 donors with high-grade CNS malignancies.Eleven donors have ever been through at least one of the four treatments （craniotomy,V-P/V-A shunt,radiotherapy and chemotherapy）,14 donors have undergone none,and the clinical data of rest were unavailable.All the 63 recipients got well renal function after transplant.During an average follow-up of （15.9 ± 8.2） months （range：2.7 to 35.5 months）,one recipient got donor-derived rhabdoid tumor 4 months posttransplant,underwent comprehensive treatments,including allograft nephrectomy,radiotherapy,chemotherpy and returned to hemodialysis,while the 62 cases got no donor-derived tumors.Conclusion Tumor transmission of renal allograft from donors with primary CNS tumors is inevitable but with low risk,which means this kind of donors can be used with careful assessment,full informed consent and good balance between wait-list death and tumor transmission.