肾移植患者术后并发原肾恶性肿瘤3例报告及文献复习

目的探讨肾移植术后患者并发原肾恶性肿瘤的临床特点及治疗方法。方法 1988年5月至2011年10月,在解放军第309医院器官移植中心接受同种异体肾移植手术的患者2016例,其中3例患者移植术后并发原肾恶性肿瘤,对这3例患者的临床资料进行回顾性分析,并结合文献进行复习。结果 3例患者中男性2例,女性1例,中位年龄43岁。肾移植术后采用钙调磷酸酶免疫抑制剂(CNI)+麦考酚吗乙酯(MMF)或硫唑嘌呤+泼尼松三联免疫抑制方案,术后1个月内移植肾功能均恢复正常。发生恶性肿瘤距肾移植术后时间分别14个月、16个月和54个月。首发症状分别为腰部疼痛1例、无痛肉眼血尿2例。3例患者均采用肾癌根治手术,病理结果分别为胚胎性横纹肌肉瘤并黏液性脂肪肉瘤1例、血管肉瘤1例和透明细胞癌1例。在保证移植肾功能的情况下均调整了免疫抑制剂用量。随访发现前2例患者发生远处转移,确诊半年内死亡,最后1例长期存活。结论肾移植患者术后原肾发生恶性肿瘤是一种严重的并发症,病死率极高。需要早期诊断,早期治疗。治疗上以肾癌根治术为主,术后保证移植肾功能正常的同时减少免疫抑制剂用量,同时辅以其他综合治疗。

The native kidney malignancy in post-renal transplant patients: a report of three cases and literature review

Objective To investigate the clinical features and therapies for native kidney malignancy in post-renal transplant patients.Methods Two thousand and sixteen cases of renal transplantation were performed in Chinese PLA 309 Hospital from May 1988 to October 2011.In these 2 016 patients,3 were complicated with native kidney malignancy.The clinical features of the three patients were analyzed retrospectively and relative literatures were reviewed.Results The three patients with native kidney malignancy included 2 male and 1 female,with the median age of 43 years.They all received triple immunosuppressive therapy including calcineurin inhibitors(CNI),mycophenolate mofetil(MMF) or azathioprine and predisone after renal transplantation.All patients’ post-operative renal function returned to normal within 1 month after transplantation.The time of occurrence of the native kidney malignancy was 14,16 and 54 months after transplantation respectively.The initial manifestation of native kidney malignancy was waist pain(1 case) and painless gross hematuria(2 cases).All three patients underwent radical nephrectomy.The pathology revealed one case of embryonal rhabdomyosarcoma combined with myxoid liposarcoma,one case of angiosarcoma and one case of clear cell carcinoma respectively.The dose of immunosuppressants was kept as low as possible in the case that the renal graft function was maintained normal.Distant metastasis occurred in the first 2 patients during follow up period.They died within half a year after diagnosis.The third one got long-term survival.Conclusions Native kidney malignancy in renal transplant recipient is a severe complication.The mortality is high.Early diagnosis and early treatment are very important.Radical nephrectomy is the main therapy for it.While the renal graft function maintains normal,the dosage of immunosuppressive agents should be kept as low as possible.