肾移植术后原肾恶性肿瘤2例报告并文献复习

目的 探讨肾移植术后原肾恶性肿瘤的临床特点,提高该疾病的临床诊治水平.方法 回顾分析经治的2例肾移植术后原肾恶性肿瘤患者的发病情况、肿瘤特点、治疗方案、随访结果和预后,复习国内外文献,针对该2病例特点进行分析总结.结果 2例患者均在规律随访时经B超发现原肾恶性肿瘤,分别为肾移植后39个月和112个月.病例1行根治性肾切除术,术后病理为透明细胞癌,术后免疫抑制剂改为包含雷帕霉素的治疗方案,至今随访8年,肿瘤无复发,移植肾功能正常.病例2发现原肾恶性肿瘤后拒绝手术治疗,6个月后肿瘤转移,失去切除肿瘤机会,采用舒尼替尼治疗4个月,因难以耐受不良反应而停药,目前门诊随访,发现肿瘤后存活18个月,移植肾功能正常.结论 肾移植术后原肾恶性肿瘤例数不多,但发生率明显高于正常人群,肾移植术后随访中应加强针对性筛查,及早发现原肾恶性肿瘤.原肾恶性肿瘤发生后如果能及时行根治性切除术,预后较好,如有转移可以采用靶向药物进行治疗.原肾恶性肿瘤术后采用包含雷帕霉素及其类似物的免疫抑制治疗方案是比较合理的选择.

Malignant tumor of native kidneys in renal transplant patients:report of two cases and literature review

Objective To explore the clinical characteristics of malignant tumor of native kid-neys in renal transplant patients,in order to improve our understanding of this disease. Methods We retrospectively summarized the clinical characteristics,surgical procedure,follow-up and progno-sis of malignant tumor of native kidneys in two renal transplant patients,and relative literature was reviewed for analysis of the features of this disease. Results Two cases were both reported malig-nant tumor in native kidney by B ultrasound scan during the regular follow-up period,at posttrans-plant 39 months and 112 months respectively.Radical nephrectomy was performed in patient No.1, and pathological type was clear cell carcinoma.Immunosuppressive regime was modified to add Rapa-mycin.Up to now,the patient has been followed up for eight years without relapse of malignancy with normal renal graft function.Patient No.2 refused surgery at the beginning of the report of ma-lignancy,somissed the chance of radical nephrectomy when he came back six months later with me-tastasizing malignancy.He then took Sunitinib for four months and quitted for unacceptable side effects.This patient has survived for 1 8 months with normal renal graft function. Conclusions The absolute number of malignancies of native kidneys in renal transplant patients is not high,but the in-cidence is obviously higher when compared with normal population.Thus,emphasizing the screening of malignancies in native kidneys in renal transplant patient is necessary.Renal malignancies in native kidneys in renal transplant patient have good prognosis when radical nephrectomy was performed. Targeted drugs could still be a selection for metastasizing malignancy.Immunosuppressive regimes including Rapamycin and its analogues are rational selection postoperatively.