| Objective: To investigate the characteristics,prevention and treatment of new malignancy after renal transplantation.Methods: A retrospective analysis was made of 1079 cases of renal allograft transplantation from January 2007 to December 2016 in our hospital.Follow-up to October 2018,21 cases of new malignancy after renal transplantation were selected according to the relevant selection criteria.The time of transplantation,the time of diagnosis,the immunosuppressive regimen before and after diagnosis,clinical symptoms,types of tumors,treatment methods,prognosis(survival time,creatinine level)and so on were collected.Results: The average age of malignancy after transplantation was 48.4 + 11.1(31-69)years.The median time from transplantation to diagnosis was 58 months.The shortest time was 17 months and the longest time was 140 months after transplantation.Adjustment of immunosuppressive regimen: After the diagnosis of malignancy,17 of the 18 patients who were given Tac+MMF+ Pred were changed to SRL+Tac+Pred.The original 3 patients who were given Cs A+MMF+Pred were all changed to SRL+Cs A+Pred.Digestive system tumors were found in 6 cases(28.6%),urinary system tumors in 5 cases(23.8%),lung malignant tumors in 3 cases(14.3%),thyroid malignancy in 2 cases(9.5%),The remaining 5 cases included non-Hodgkin’s lymphoma,nasal basal cell carcinoma,nasopharyngeal carcinoma,cervical cancer and breast cancer.Among them,8 cases had distant metastases when tumors were found,accounting for 38.1% of all malignancy.Surgical treatm ent was performed in 14 cases(66.7%),radiotherapy and chemotherapy in 6 cases(28.6%)and abandonment of treatment in 1 case(4.7%).By October 2018,8 out of 21 patients had died,including 5 males and 3 females.The time from diagnosis of malignancy to de ath was 7-37 months,and the median survival time was 15 months.13 patients still survived.The median survival time was 27 months,ranging from 3 to 70 months after the diagnosis of malignancy.At the time of diagnosis,20 patients had normal renal allograft function(creatinine ranged from 53 to 106 umol/L),and 1 patient had renal insufficiency.By the deadline,19 cases had normal renal function,7 of them had died and 18 survived.One patient with normal renal function progressed to renal insufficiency at diagnosis,and one patient with renal insufficiency progressed to renal allograft failure at diagnosis(hemodialysis started half a year before death).Conclusion: The incidence of malignancy after kidney transplantation is higherth an that of the general population.The incidence of malignant tumors in digestive system and urinary system is the highest in ourhos p it a l.Th e hig h i n ci d en-c e o f ma l i g n a n c y aft e r r e n al transplantation is the result of multiple factors,including immunosuppressive status,use of immunosuppressive drugs,carcinogenic virus infection or reactivation.Renal transplantation hasa high degree of malignancy and poor prognosis.Regular review is helpful for early detection and treatment.Adjustment of immunosuppressive regimen is very important for the prevention andtr eatment of malignancy.The appropriate immunosuppressive regimen should be formulated according to individual conditions to ac hieve a balance between anti-rejection and anti-tumour.Surgery is the main treatment,supplemented by radiotherapy,chemotherapy and immunosuppressive therapy. |
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