肾移植术后并发恶性肿瘤分析

目的 了解恶性肿瘤在肾移植患者中的发病率,并探讨其发病率增高的机制.方法 回顾性分析1998～2005年接受免疫抑制治疗的829例肾移植患者中15例发生恶性肿瘤的病例.恶性肿瘤总发病率为1.9%,其中泌尿系统肿瘤占66.7%,肝癌占13.3%,淋巴瘤、皮肤癌及肺癌各占6.7%.结果 15例患者肾移植术后肿瘤诊断时间为20～73个月,平均时间54.7个月.诊断肿瘤时14例患者肾功能正常,1例患者肾功能失功能.发现肿瘤时均无远处转移,3例肾盂尿路上皮癌患者肿瘤侵犯输尿管腔.肿瘤治疗以手术治疗为主,并及时调整减少免疫抑制药物剂量,辅以化疗和放疗、免疫治疗.结论 肾移植患者发生恶性肿瘤除了与应用免疫抑制治疗有关,也不能忽视移植术本身及肾移植术前原发病带来的影响.

Analysis on the occurrence of malignant tumors after kidney transplantation

Objective To study the incidence of malignant tumors in the patients undergone renal transplantation, and to explore the mechanism of higher incidence. Methods A retrospective study was performed on 829 patients undergone renal transplantation followed by immunosuppression therapy from 1998-2006. 15 cases developed malignant tumors among the 829 patients with incidence of 1. 9%. The incidence of urinary system tumor was 66. 7%, of hepatoma was 13. 3%, and 6. 7% for lymphoma, cutaneous cancer and pulmonary carcinoma respectively. Results 15 patients suffered from renal tumors 11- 73 months after kidney transplantation, in whom renal function was normal in 14 patients, and in 1 patient the grafted kidney showed dysfunction. No tumor metastasis was found in those cases, except in 3 patients ureteral lumen infiltration was found. Most patients accepted operations, with the dose of the immuosurpression drugs adjusted or reduced, and supplemented with chemotherapy or rediotherapy and immunotherapy. Conclusions The pathogenesis might be related with immunosuppression drugs postoperatively, and also the effects of transplantation itself and the primary disease before transplantation, for instance, umepithelium malignancy was prolonged medication was frequently the reason for renal transplantation.