肾移植受体术后免疫抑制剂治疗对新发恶性肿瘤发生率及影响因素分析

Incidence and Influencing Factors of De novo Malignant Tumors Treated by Immunosuppressive Therapy after Renal Transplantation

目的:分析肾移植术后长期服用免疫抑制剂治疗患者恶性肿瘤的发生率,并探讨患者新发恶性肿瘤的影响因素,为肾移植术后免疫抑制剂治疗患者继发恶性肿瘤的早期诊断和防治提供参考依据。方法:回顾性收集2007年8月至2020年12月期间在我院器官移植中心完成肾移植且术后免疫抑制剂治疗期间随访均已获得的肾移植受体患者1 028例作为研究对象,随访患者恶性肿瘤的发病率,采用单因素分析及多因素Logistic回归模型探讨肾移植受体术后长期服用免疫抑制剂治疗对新发恶性肿瘤的影响。结果:新发恶性肿瘤30例,发生率为2.92%。恶性肿瘤确诊中位时间为肾移植术后58(12~144)个月,其中有5例(16.67%)在术后2年内发病、11例(36.67%)在术后5年内发病、14例(46.67%)在术后5年后发病。不同免疫抑制剂治疗方案患者恶性肿瘤的新发生率之间差异无统计学意义(χ^(2)=1.758,P=0.415)。单因素及多因素Logistic回归分析,结果显示:有肿瘤家族史、FK50血药浓度高、Treg细胞水平高是肾移植术后长期免疫抑制剂治疗患者新发恶性肿瘤的独立影响因素(P<0.05)。结论:肾移植术后长期服用免疫抑制剂治疗患者的恶性肿瘤发病风险较高,肿瘤家族史、血药浓度、Treg细胞水平是其影响因素。

Objective: To analyze the incidence of malignant tumors in patients treated with immunosuppressants for a long time after renal transplantation, and explore the influencing factors of new malignant tumors, so as to provide basis for early diagnosis, prevention and treatment of secondary malignant tumors in patients concerned. Methods: 1,028 renal transplant recipients who had been followed up after transplantation followed by immunosuppressive therapy from August 2007 to December 2020 were retrospectively collected. The incidence of malignant tumors was followed up. Univariate analysis and multivariate logistic regression model were used to explore the influencing factors of new malignant tumors in patients receiving long-term immunosuppressive therapy after renal transplantation. Results: There were 30 cases of new malignant tumors, and the incidence was 2.92%. The median time to diagnosis was 58(12-144) months after renal transplantation, including 5 cases(16.67%) less than 2 years after surgery, 11 cases(36.67%) less than 5 years after surgery and 14 cases(46.67%) more than 5 years after surgery. There was no significant difference in the new incidence of malignant tumors among patients with different immunosuppressive regimens(χ^(2)=1.758, P=0.415). Univariate and multivariate logistic regression analyses showed that family history of cancer, high serum FK50 concentration and high level of Treg cells were independent influencing factors of new malignant tumors in patients treated with long-term immunosuppressive therapy after renal transplantation(P<0.05). Conclusion: There is a higher risk of malignant tumors in patients receiving long-term immunosuppressive therapy after kidney transplantation. Family history of cancer, blood drug concentration and Treg cell levels are the influencing factors.