Malignancy in Renal Transplant Recipients Exposed to Cyclophosphamide Prior to Transplantation for the Treatment of Native Glomerular Disease
Malignancy in Renal Transplant Recipients Exposed to Cyclophosphamide Prior to Transplantation for the Treatment of Native Glomerular Disease
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DOI：
10.1002/phar.2059
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发表时间：
2018-01-01
期刊：
影响因子：
4.1
通讯作者：
Panzer, Sarah E.
中科院分区：
文献类型：
--
作者：
Jorgenson, Margaret R.;Descourouez, Jillian L.;Panzer, Sarah E.
研究目的评估肾移植受者在移植前暴露于环磷酰胺治疗肾小球肾病（GN）的移植后恶性肿瘤的风险。设计回顾性队列研究。设置三级学术医疗中心。患者600名成人肾移植受者在1993年至2014年期间接受移植; 54例患者在移植前接受环磷酰胺治疗GN（GN-CYC组），546例多囊肾患者在移植前未暴露于环磷酰胺测量和主要结果数据收集回顾性电子病历。主要结果是移植后恶性肿瘤的发生。在中位随访5.5年期间，130例患者发生恶性肿瘤（发生率为3.5例事件/100人-年）。移植前暴露于环磷酰胺与移植后恶性肿瘤显著相关（校正的风险比[aHR] 2.20，95%置信区间[CI] 1.16-4.22，p=0.02），特别是皮肤癌（aHR 2.24，95% CI 1.09-4.60，p=0.03）。与巴利昔单抗诱导相比，GN-CYC组在淋巴细胞耗竭诱导（阿仑单抗; aHR 4. 53，95% CI 0. 99 - 20. 72，p= 0. 05）的情况下的乳腺癌风险更高。GN-CYC和PKD groups.ConclusionIn我们的观察性研究中，肾移植受者暴露于移植前环磷酰胺似乎有更高的风险发展成恶性肿瘤相比，未暴露的肾移植受者之间的死亡审查移植物丢失和死亡率是相似的。进一步研究移植前免疫抑制对恶性肿瘤的影响，特别是与淋巴细胞耗竭诱导的复合效应，是必要的。
Study ObjectiveTo evaluate the risk of posttransplantation malignancy in renal transplant recipients exposed to pretransplantation cyclophosphamide for the treatment of glomerular nephropathy (GN).DesignRetrospective cohort study.SettingTertiary academic medical center.PatientsSix hundred adult renal transplant recipients were transplanted between 1993 and 2014; 54 patients were exposed to pretransplantation cyclophosphamide for treatment of GN (GN-CYC group), and 546 patients with polycystic kidney disease were not exposed to pretransplantation cyclophosphamide (PKD group).Measurement and Main ResultsData were collected retrospectively from electronic medical records. The primary outcome was occurrence of posttransplantation malignancy. During a median follow-up of 5.5 years, 130 patients developed malignancy (incidence rate 3.5 events per 100 person-yrs). Exposure to cyclophosphamide before transplantation was significantly associated with malignancy after transplantation (adjusted hazard ratio [aHR] 2.20, 95% confidence interval [CI] 1.16-4.22, p=0.02), specifically skin cancer (aHR 2.24, 95% CI 1.09-4.60, p=0.03). Malignancy risk in the GN-CYC group was higher in the setting of lymphocyte-depleting induction (alemtuzumab; aHR 4.53, 95% CI 0.99-20.72, p=0.05) compared with basiliximab induction. Incidences of death-censored graft loss and mortality were similar between the GN-CYC and PKD groups.ConclusionIn our observational study, renal transplant recipients exposed to pretransplantation cyclophosphamide appeared to have a higher risk of developing a malignancy compared with unexposed renal transplant recipients. Further investigation into the impact of pretransplantation immunosuppression on malignancy, particularly the compounded effect with lymphocyte-depleting induction, is warranted.