Hepatocellular carcinoma after kidney transplantation: analysis of Hong Kong Renal Registry
Hepatocellular carcinoma after kidney transplantation: analysis of Hong Kong Renal Registry
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DOI：
10.3109/0886022x.2014.899879
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发表时间：
2014-07-01
期刊：
影响因子：
3
通讯作者：
Chau, Ka Foon
中科院分区：
文献类型：
--
作者：
Cheung, Chi Yuen;Lam, Man Fai;Chau, Ka Foon
与一般人群相比，肾移植受者患癌症的风险增加。肝细胞癌（HCC）在亚洲是极其重要的，因为亚洲是B型肝炎病毒（HBV）感染的地方病。目的是研究我们的肾移植受者中所有原发性肝癌的流行病学和临床方面。此外，还将讨论可能有助于优化结果的各种预防策略。根据香港肾脏登记中心的数据，对1972年5月至2011年12月期间在香港肾移植后发生HCC的所有患者进行回顾性分析。经过40,246人年的随访，20例患者（男性15例，女性5例）发生了HCC。年发病率为49.7/10万人/年。其中HBV携带者16例，HCV携带者2例，HBV和HCV合并感染者2例。HBV感染的存在与肝癌发生的风险增加78倍相关。大多数（85%）无症状时，肝癌诊断超声或甲胎蛋白监测。所有经监测确诊的患者均得到积极治疗，2/3有症状的患者仅能接受对症治疗，并迅速死亡。结论：HBV感染是HBV流行区肾移植受者发生肝细胞癌的主要病因。定期的HCC监测似乎能够检测出适合治疗的早期癌症，并提供治愈的最佳希望。
Kidney transplant recipients have increased risk of cancers when compared with the general population. Hepatocellular carcinoma (HCC) is extremely important in Asia where hepatitis B virus (HBV) infection is endemic. The aim is to study the epidemiological and clinical aspects of all de novo HCC in our kidney transplant recipients. Moreover, various preventive strategies which may help to optimize the outcome will also be discussed. A retrospective review of all patients who developed HCC after kidney transplantation between May 1972 and December 2011 in Hong Kong, based on the data from Hong Kong Renal Registry. After a follow-up period of 40,246 person-years, 20 patients (males 15: females 5) developed HCC. The annual incidence was 49.7/100,000 persons per year. Among them, 16 were HBV carriers, 2 were hepatitis C (HCV) carriers and 2 had HBV and HCV co-infection. Presence of HBV infection was associated with 78-fold higher risk for HCC development. Majority (85%) were asymptomatic when HCC was diagnosed by ultrasound or alpha-fetoprotein surveillance. All patients diagnosed by surveillance received active treatment while 2/3 of symptomatic patients could only receive symptomatic care and died rapidly. In conclusion, HBV infection is the major etiological factor for HCC development in kidney transplant recipients in HBV endemic areas. Regular HCC surveillance appeared to be able to detect early stage cancers which are amenable to treatment and offer the best hope of cure.