肾移植术后新发恶性肿瘤临床分析

目的探讨肾移植术后新发恶性肿瘤的临床特征。方法回顾性分析2001年6月至2005年1月在中山大学附属第五医院行‘肾移植术后生存半年以上并能接受定期随访的236例受者中新发恶性肿瘤患者的临床资料。结果在236例肾移植受者中，共有新发恶性肿瘤5例，发生率2．1％（5／236）。患者均为男性，新发肿瘤类型分别为直肠癌2例、肺癌1例、移行细胞癌1例、非霍奇金淋巴瘤1例。患者肾移植时年龄为46—70岁，平均年龄61岁，肿瘤确诊时的年龄为48～73岁，平均年龄65岁；从接受。肾移植手术至发生肿瘤的时间为14～77个月，平均时间46个月。5例患者经确诊为新发恶性肿瘤后，给予手术治疗和（或）化学药物治疗及减少免疫抑制剂或者转换免疫抑制方案治疗，均未发生肾功能异常和排斥反应。其中2例患者死于肿瘤进展和多器官功能衰竭，3例存活。结论 肾移植术后新发恶性肿瘤进展隐匿迅速，早期诊断、早期治疗是提高其疗效的关键措施。

Clinical analysis of de novo malignancies after renal transplantation

Objective To investigate the clinical characteristics of de novo malignancy after renal transplantation. Methods Clinical data of patients with de novo malignancies out of 236 patients who were performed renal transplantation and followed up for more than 6 months in the Fifth Affiliated Hospital of Sun Yat-sen University from June 2001 to January 2005 were analyzed retrospectively. Results In these 236 patients, 5 patients developed de novo malignancies. The incidence was 2. 1% （5/236）. All of 5 patients were male. The types of de novo malignancies included rectal cancer（ n = 2 ） , lung cancer（ n = 1 ） , transitional cell carcinoma（ n = 1 ） and non-Hodgkin lymphoma（ n = 1 ）. The mean age of 5 patients at renal transplantation was 61 years old （range from 46 to 70 years old）, and 65 years old （range from 48 to 73 years old） at diagnosis of malignancies. The duration from transplantation to diagnosis was 46 months （range from 14 to 77 months ）. After diagnosis of de novo malignancies, 5 patients underwent surgery and （or） chemotherapy with reducing or changing immunosuppressant. No abnormal renal function or rejection occurred. Two cases died of tumor progression and multiple organ failure. Three cases survived. Conclusions The progress of de novo malignancies after renal transplantation is insidious and rapid. Early diagnosis and early treatment are the key measures to improve the therapeutic efficacy.