Clinical Analysis Of Malignancy After Kidney Transplantation

BackgroundWith the continuouly increase of kidney transplantation operations in China and the application of immunosuppressive drug,malignant tumors after kidney transplantation have become one of the important reasons affecting the long-term survival of transplant recipients.More and more attention has been paid to the clinical characteristics,early screening and prevention of malignant tumors after kidney transplantation.In this study,we analyzed the basic information,pathological types,incidence,survival of malignant tumor recipients after kidney transplantation in our center and investigating the risk factors for malignancy in kidney transplant recipients.MethodsThe clinical data of 1549 recipients who received kidney transplantation in the organ transplantation department of Nanfang Hospital of Southern Medical University on January 1,2003 and December 31,2018 were retrospectively analyzed.Data were collected including date of birth,sex,family history,age at the time of transplantation,date at the time of transplantation,type of immunosuppressant used after surgery,incidence of acute rejection and delayed recovery of graft function,age at diagnosis of tumor,site of tumor,clinical feature,pathological type,stage,and patients’prognosis.ResultsIn the center of 1549 renal transplant recipients,with a total of 47 recipients postoperatively malignant tumor,including 9 cases of colorectal cancer,5 cases of PTLD,5 cases of liver cancer,5 cases of kidney malignant tumor,4 cases of bladder cancer,3 cases of cervical cancer,3 cases of lung cancer,2 cases of gastric carcinoma,2 cases of prostate cancer,2 cases of breast cancer,1 case of pancreatic head carcinoma,1 cases of skin cancer,1 case of thyroid carcinoma,1 cases of retroperitoneal tumors,1 case of primitive neural ectoderm tumor,1 cases of intrauterine membrane carcinoma,1 case of mouth floor carcinoma.There were 15 cases of stage Ⅰ,11 cases of stage Ⅱ,9 cases of stage III and 12 cases of stage Ⅳ.The age of malignancy after kidney transplant was 48.3± 11.8 years at the time of transplantation and 54.8± 12.0 years at the time of diagnosis,and the time from transplantation to diagnosis of malignant tumor was 66(36,100)months.In terms of malignant tumor types,colorectal cancer was the most common,with a cumulative incidence of 0.58%,followed by liver cancer,PTLD and renal malignancy,with a cumulative incidence of 0.32%.The survival time of 47 patients with malignant tumor after kidney transplantation was 59(2,135)months,and the 5-year survival rate was 49.9%.The 5-year survival rate of kidney transplantation recipients without malignant tumor was 95.5%,which was significantly higher than that of recipients with malignant tumor after renal transplantation.Recipients’ age of>45 years at the time of transplantation was a risk factor for malignant tumor after renal transplantation(P<0.05).ConclusionsCompared with the general population,the incidence of malignant tumors in kidney transplant recipients in our hospital was significantly higher,among which the incidence of malignant tumors in the digestive tract and urinary system was the highest,and the 5-year survival rate of malignancy after kidney transplant in our center was 49.9%,which was lower than that of kidney transplant recipients without tumor in the same period,gender and age matching.kidney transplant recipients need regular reexaminations after surgery to screen for malignant tumors early,especially those with high risk of cancer,such as elderly age,longer transplant years,preoperative tumor history and oncogenic virus infection.For example,the immune status of kidney transplant recipients should be regularly assessed,and tumor marker detection should be performed regularly.For gastrointestinal malignancy,helicobacter pylori can be monitored regularly and gastroenteroscopy can be performed.For malignant tumors of the urinary system,urinalysis,primary kidney,graft,ureter,bladder and prostate ultrasonography can be performed regularly,and cystoscopy or other high-resolution imaging examinations should be performed in time when hematuria and tumors are found.Prevention of risk factors for posttransplant malignancy is also important.These include:the use of individualized immunosuppression programmes;Rationally adjust the dose of immunosuppressive drugs;Prevention of oncogenic virus infection,etc.