肾移植患者并发恶性肿瘤(附5例临床分析)

目的探讨同种异体肾移植受者并发恶性肿瘤的临床情况。方法回顾分析我院1977年7月～1999年12月898例(903例次)肾移植受者术后并发恶性肿瘤及其治疗。结果术后发生恶性肿瘤5例，发生率为0.6％。其中膀胱肿瘤2例，肝癌1例，Kaposi'8肉瘤1例，非何杰金淋巴瘤1例。平均年龄56.6±3.7岁。移植术后至肿瘤诊断时间8～48(平均27±17)个月。诊断肿瘤时5例患者肾功能正常，未有远处转移。经根治性手术切除肿瘤为主的综合治疗，包括减少免疫抑制剂用量，5例患者全部治愈。经随访11～50(平均28±15)个月，肿瘤无复发，肾功能正常，无排斥反应发生。结论肾移植患者恶性肿瘤的发生及种类与国外有较大区别。早期诊断，早期治疗是提高治愈率的关键。根治性手术切除肿瘤应为首选，同时减少免疫抑制剂用量。建立完善的肾移植术后随访制度有利于早期发现肿瘤。

AN ONE-CENTER EPIDEMIOGRAPHIC ANALYSIS OF MALIGNANCY IN RENAL ALLOGRAFY RECIPIENTS

OBJECTIVE To analyze the epidemiographic features of malignancy in renal allograft recipients in a single center.METHODOLOGY This analysis included 898 patients who received renal allografts between July 1997 and December 1999 andanti-rejection treatment for at least 3 months. RESULTS After transplantation among the 898 recipients, 5 (a incidence about0.6% )were diagnosed with malignancies that included bladder transitional cell carcinoma, squanous bladder cell carcinoma, pri-mary liver cell carcinoma,non-Hodgkin' s lymphoma, Kaposi' s sarcoma. The mean age at diagnosis of malignancy was 56.6+ 3.7(range 51-56)years,and the mean duration of immunosuppressive treatment 27 ± 17(range 8-48)months. Four of the patients wereon cyclosporin-azathioprine-prednisolone,and one on cyclosporin-mofetil-prednisolone regime. The treatments for malignancies con-sisted of completely removal of tumor mass, decrement of immunosuppressive treatment (cyclosporin by 1/2-1/3, azathioprine/mofetil by 1/2 or withdrawal),chemotherapy or radiotherpay, and traditional Chinese medicine. All the five cases were cured andhave been followed-up for 28 ± 15(range 11-50)months without malignance recurrence, allograft dysfunction, or episode of rejec-tion. CONCLUSION Malignance is an important complication in renal transplantation. Strict follow-up and early diagnosis arecritical.