New concepts and best practices for management of pre- and post-transplantation cancer
New concepts and best practices for management of pre- and post-transplantation cancer
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DOI：
10.1016/j.trre.2012.07.001
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发表时间：
2012-10-01
影响因子：
4
通讯作者：
Ussetti, Piedad
中科院分区：
文献类型：
--
作者：
Campistol, Josep M.;Cuervas-Mons, Valentin;Ussetti, Piedad
与一般人群相比，实体器官移植受者患癌症的风险增加。肿瘤可以是原发性的，也可以是原有恶性肿瘤的复发，或者来自捐赠的器官。由西班牙移植专家组成的ATOS（Aula sobre Trasplantes de Organos Solidos;固体器官移植工作组）小组每年举行会议，讨论该领域的最新进展。2011年，第11版涵盖了一系列关于癌症和移植的新主题。在这篇综述中，我们强调了ATOS会议上提出的在移植前和移植后环境中管理癌症的新概念和最佳实践。免疫抑制在移植受者的肿瘤发生中起主要作用，通过受损的免疫监视和通过直接致癌活性。只要遵循有效的最小化恶性肿瘤传播策略，就有可能移植从有癌症史的供体获得的器官。针对有恶性肿瘤病史的移植候选者数量的增加，提出了肿瘤特异性等待期;然而，必须考虑患者因器官衰竭死亡的个体风险。积极预防肿瘤复发，特别是肝移植受者中肝细胞癌的复发非常重要。为了有效地管理移植后恶性肿瘤，必须主动监测患者，长期强化筛查计划显示移植后癌症的发病率降低。建议的移植后恶性肿瘤的管理策略包括病毒监测和预防，以减少感染相关的癌症，免疫抑制调节与低剂量的钙调磷酸酶抑制剂，并添加或转换为抑制剂的哺乳动物雷帕霉素的目标。(C)2012年由Elsevier Inc.出版
Solid-organ transplant recipients are at increased risk of developing cancer compared with the general population. Tumours can arise de novo, as a recurrence of a preexisting malignancy, or from the donated organ. The ATOS (Aula sobre Trasplantes de Organos Solidos; the Solid-Organ Transplantation Working Group) group, integrated by Spanish transplant experts, meets annually to discuss current advances in the field. In 2011, the 11th edition covered a range of new topics on cancer and transplantation. In this review we have highlighted the new concepts and best practices for managing cancer in the pre-transplant and post-transplant settings that were presented at the ATOS meeting. Immunosuppression plays a major role in oncogenesis in the transplant recipient, both through impaired immunosurveillance and through direct oncogenic activity. It is possible to transplant organs obtained from donors with a history of cancer as long as an effective minimization of malignancy transmission strategy is followed. Tumour-specific wait-periods have been proposed for the increased number of transplantation candidates with a history of malignancy; however, the patient's individual risk of death from organ failure must be taken into consideration. It is important to actively prevent tumour recurrence, especially the recurrence of hepatocellular carcinoma in liver transplant recipients. To effectively manage post-transplant malignancies, it is essential to proactively monitor patients, with long-term intensive screening programs showing a reduced incidence of cancer post-transplantation. Proposed management strategies for post-transplantation malignancies include viral monitoring and prophylaxis to decrease infection-related cancer, immunosuppression modulation with lower doses of calcineurin inhibitors, and addition of or conversion to inhibitors of the mammalian target of rapamycin. (C) 2012 Published by Elsevier Inc.