Erol Demir, Mevlut Tamer Dincer, Cebrail Karaca, Cansu Erel, Latif Karahan, Aslihan Pekmezci, Sinan Trabulus, Nurhan Seyahi, Aydin Turkmen
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引用次数: 0
Abstract
Background: Malignancies are the third leading cause of death among kidney transplant recipients. These patients face increased mortality and challenges such as allograft loss and rejection, which may arise from surgical complications, changes in immunosuppressive therapy or the use of chemotherapeutics. This study aims to examine the risk of allograft rejection and loss in kidney transplant recipients diagnosed with de novo malignancies.
Methods: This retrospective case-control study included adult kidney transplant patients from 1986 to 2020 who developed de novo malignancies. Each patient with a malignancy was matched with a control without malignancy using the nearest neighbor matching method. The outcomes measured were biopsy-confirmed allograft rejection, death-censored allograft loss and overall mortality after the diagnosis of malignancy in the malignancy group and at any point in the control group.
Results: Of 2750 records reviewed, 267 patients (9.7%) had biopsy-confirmed malignancies, with a median age of 60 years and 66.3% men. The median follow-up was 218 months. Kaplan-Meier analysis showed that the allograft rejection rates were lower in the malignancy group compared with the control group (26 vs 60, P < .001). Overall mortality was higher in the malignancy group, although this difference was not statistically significant (104 vs 73, P = .25). Death-censored allograft loss was similar between groups (22 vs 32, P = .49). Chemotherapy and older recipient age were associated with reduced allograft rejection risk, as indicated by multivariable regression analysis.
Conclusions: In kidney transplant recipients with de novo malignancies, death with a functioning graft remains significant. However, allograft loss rates do not increase compared with those without malignancies, and rejection risk is reduced, especially in older and chemotherapy-treated patients. These findings suggest that managing immunosuppression reduction in this population may be appropriate, but further research is needed to determine optimal care strategies.
背景：恶性肿瘤是肾移植受者死亡的第三大原因。这些患者面临着更高的死亡率和挑战，如同种异体移植物丢失和排斥反应，这可能由手术并发症、免疫抑制疗法的改变或化疗药物的使用引起。本研究旨在检查诊断为新发恶性肿瘤的肾移植受者发生同种异体移植排斥反应和丧失的风险。方法：这项回顾性病例对照研究包括1986年至2020年发生新发恶性肿瘤的成人肾移植患者。采用最近邻匹配法将每例恶性肿瘤患者与无恶性肿瘤的对照组进行匹配。测量的结果是在恶性肿瘤组和对照组的任何时间点，活检证实的同种异体移植排斥反应、死亡审查的同种异体移植损失和诊断为恶性肿瘤后的总死亡率。结果：在回顾的2750例记录中，267例（9.7%）患者活检证实为恶性肿瘤，中位年龄为60岁，66.3%为男性。中位随访时间为218个月。Kaplan-Meier分析显示，恶性肿瘤组的排斥反应率低于对照组（26 vs 60, P = 0.25）。同种异体移植物死亡损失在两组之间相似（22 vs 32, P = 0.49）。多变量回归分析表明，化疗和年龄较大的受体与同种异体移植排斥风险降低相关。结论：在新发恶性肿瘤的肾移植受者中，功能正常的移植物的死亡率仍然很高。然而，与没有恶性肿瘤的患者相比，同种异体移植物的失取率没有增加，排斥风险降低，特别是在老年人和接受化疗的患者中。这些发现表明，在这一人群中控制免疫抑制的减少可能是合适的，但需要进一步的研究来确定最佳的护理策略。
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About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
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