Solid Organ Transplantation in Patients With Preexisting Malignancies in Remission: A Propensity Score Matched Cohort Study
Solid Organ Transplantation in Patients With Preexisting Malignancies in Remission: A Propensity Score Matched Cohort Study
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DOI：
10.1097/tp.0000000000002178
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发表时间：
2018-07-01
期刊：
影响因子：
6.2
通讯作者：
Baxter, Nancy N.
中科院分区：
文献类型：
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作者：
Acuna, Sergio A.;Sutradhar, Rinku;Baxter, Nancy N.
背景：与无恶性肿瘤病史的受者相比，移植前有恶性肿瘤（PTM）的实体器官移植受者的总生存率（OS）较差。然而，它是未知的死亡率的增加的风险是否是由于复发性癌症相关的deaths.Methods所有的实体器官移植受者在安大略之间的1991年和2010年进行了识别和匹配1：2的收件人没有PTM使用的倾向评分。使用Kaplan-Meier估计值和考克斯比例风险模型比较OS。对于癌症特异性死亡率和癌症复发，原因特异性风险模型和累积发病率进行了plotted.Results收件人与PTM有一个更糟糕的OS相比，收件人没有PTM（中位OS，10.3年对13.4年）。PTM患者不仅癌症特异性死亡风险增加（原因特异性风险比，1.85; 95%置信区间[CI]，1.20-2.86），而且非癌症死亡风险增加（原因特异性风险比，1.29; 95% CI，1.08-1.54）。与无PTM的受者相比，有高风险PTM的受者有更高的全因死亡率（风险比，1.81; 95%CI，1.47-2.23）。低风险PTM受者的风险并没有增加（风险比，1.06; 95%CI，0.86-1.31）。结论与非PTM受者相比，PTM受者的全因死亡率的风险增加。这种增加的风险在癌症特异性和非癌症死亡率中都有发现。然而，只有那些高风险的PTM有更差的结果。
Background Solid-organ transplant recipients with pretransplant malignancies (PTM) have worse overall survival (OS) compared to recipients without history of malignancy. However, it is unknown whether the increased risk of mortality is due to recurrent cancer-related deaths.Methods All solid-organ transplant recipients in Ontario between 1991 and 2010 were identified and matched 1:2 to recipients without PTM using a propensity score. OS was compared using the Kaplan-Meier estimator and Cox proportional hazard models. For cancer-specific mortality and cancer recurrence, cause-specific hazard models were used and the cumulative incidence was plotted.Results Recipients with PTM had a worse OS compared with recipients without PTM (median OS, 10.3 years vs 13.4 years). Recipients with PTM were not only at increased risk of cancer-specific mortality (cause-specific hazard ratio, 1.85; 95% confidence interval [CI], 1.20-2.86) but also at increased risk of noncancer death (cause-specific hazard ratio, 1.29; 95% CI, 1.08-1.54). Compared with recipients without PTM, recipients with high-risk PTM had higher all-cause mortality (hazard ratio, 1.81; 95% CI, 1.47-2.23). Recipients with low-risk PTM were not at increased risk (hazard ratio, 1.06; 95% CI, 0.86-1.31).Conclusions Recipients with PTM are at increased risk of all-cause mortality compared to recipients without PTM. This increased risk was noted for both cancer-specific and noncancer mortality. However, only those with high-risk PTM had worse outcomes.