25 Malignancy after heart transplantation

Q2 Medicine
K. Fan
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引用次数: 0

Abstract

In the current era, approximately 50% of heart transplant (HTx) recipients survive more than 13 years, with an increasing population of patients surviving beyond 20 years. Previous studies have suggested that HTx recipients are at particularly high risk of developing de novo malignancies due to more intensive immunosuppression. The perception of higher risk for post-transplant lymphoproliferative disease (PTLD; e.g. lymphoma) associated with OKT3 led to a fall in the use of OKT3 during the 1990s. Main advances in post-HTx management with probable reduction of risk for neoplasia are introduction of (1) antiviral prophylaxis, (2) induction agents that are more specific in their actions and (3) the mammalian target-of-rapamycin inhibitors (mTORs). Reported incidence of post-transplant malignancy in HTx recipients ranged from 2.3% to 27% and skin malignancies represented up to 50% of post-transplant malignancies. The second most common cancer in HTx recipients was PTLD. A retrospective analysis included 17 587 adult HTx recipients who were followed for up to five years post-operation.1 The incidence of de novo malignancy was 10.7% one to five years after transplantation, with higher prevalence in the contemporary era. Considering the increased burden of de novo malignancy in HTx recipients, additional effort needs to be directed towards formulating evidence-based cancer screening recommendations and optimised immunosuppression protocols for these patients. It may be reasonable to consider the risk of de novo post transplant malignancy in older patients when making decisions regarding candidacy for HTx versus left ventricular assist device as destination. References Youn JC, Stehlik J, Wilk AR, Cherikh W, Kim IC, Park GH, Lund LH, Eisen HJ, Kim DY, Lee SK, Choi SW, Han S, Ryu KH, Kang SM, Kobashigawa JA. Temporal trends of de novo malignancy development after heart transplantation. J Am Coll Cardiol 2018;71:40–49.
25 心脏移植后的恶性肿瘤
在当前时代,大约50%的心脏移植(HTx)接受者存活超过13年,越来越多的患者存活超过20年。先前的研究表明,由于更强烈的免疫抑制,HTx受体发生新发恶性肿瘤的风险特别高。认为与OKT3相关的移植后淋巴增生性疾病(PTLD;例如淋巴瘤)的风险更高,导致OKT3的使用在20世纪90年代下降。HTx治疗后可能降低肿瘤风险的主要进展是引入了(1)抗病毒预防,(2)作用更特异的诱导剂,以及(3)雷帕霉素抑制剂(mTORs)的哺乳动物靶点。据报道,HTx受体移植后恶性肿瘤的发生率为2.3%至27%,皮肤恶性肿瘤占移植后恶性疾病的50%。HTx受体中第二常见的癌症是PTLD。回顾性分析包括17 587名成年HTx接受者,术后随访长达五年。1移植后一至五年,新发恶性肿瘤的发生率为10.7%,在当代发病率更高。考虑到HTx受者新发恶性肿瘤负担的增加,需要进一步努力制定基于证据的癌症筛查建议,并优化这些患者的免疫抑制方案。在决定是否将HTx与左心室辅助装置作为目的地时,考虑老年患者移植后新发恶性肿瘤的风险可能是合理的。参考文献Youn JC,Stehlik J,Wilk AR,Cherikh W,Kim IC,Park GH,Lund LH,Eisen HJ,Kim DY,Lee SK,Choi SW,Han S,Ryu KH,Kang SM,Kobashigawa JA。心脏移植后新发恶性肿瘤发展的时间趋势。《美国心血管杂志》2018;71:40–49。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Heart Asia
Heart Asia Medicine-Cardiology and Cardiovascular Medicine
CiteScore
2.90
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0.00%
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