Malignancy risk in kidney transplant recipients exposed to immunosuppression pre-transplant for the treatment of glomerulonephritis.
Malignancy risk in kidney transplant recipients exposed to immunosuppression pre-transplant for the treatment of glomerulonephritis.
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肾移植受者在移植前接受免疫抑制治疗肾小球肾炎的恶性肿瘤风险。
DOI：
10.1093/ndt/gfac337
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Derebail,VimalK
中科院分区：
文献类型：
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作者：
Massicotte-Azarniouch,David;Detwiler,RandalK;Hu,Yichun;Falk,RonaldJ;Saha,ManishK;Hogan,SusanL;Derebail,VimalK
以肾小球肾炎(GN)为原发病的肾移植患者可能会在移植前接受大量的免疫抑制(PTI)，这可能会增加移植后发生恶性肿瘤的风险。将接受PTI治疗的GN患者(n=184)与非糖尿病、未接受PTI的肾移植患者(n=1579)进行比较。我们计算了首次发生实体或血液系统恶性肿瘤、非黑色素瘤皮肤癌(NMSC)和移植后淋巴组织增生性疾病(PTLD)的风险比(HR)，95%可信区间(95%CI)。结果在平均5.7年的随访期中，与对照组相比，PTI显著增加了恶性风险[分别为13.0%和9.7%；调整后的HR为1.82(95%CI为1.10-3.00)]，但与NMSC无关[分别为10.3%和11.4%；调整后的HR 1.09(95%CI 0.64-1.83)]或PTLD[分别为3.3%和3.1%；调整后的HR 1.02(95%CI 0.40-2.61)]。移植前接受环磷酰胺[HR 2.59(95%CI 1.48~4.55)]或利妥昔单抗[HR 3.82(95%CI 1.69~8.65)]的患者发生恶性病变的风险显著增加，尤其是同时接受环磷酰胺和利妥昔单抗治疗的患者，而不使用钙调神经磷酸酶抑制剂或霉酚酸酯的患者。结论PTI治疗肾小球肾炎，尤其是环磷酰胺，甚至联合利妥昔单抗，会增加移植后发生实体或恶性血液病的风险。这些数据突出了治疗肾小球肾炎的潜在风险，并强调了在这一患者群体中进行移植后恶性肿瘤监测的重要性。
BackgroundKidney transplant patients with glomerulonephritis (GN) as their native disease may receive significant amounts of pre-transplant immunosuppression (PTI), which could increase the risk for development of malignancy post-transplant.MethodsWe conducted a single-center, retrospective study of kidney transplant recipients from January 2005 until May 2020. Patients with GN as their native kidney disease who received PTI for treatment of GN (n= 184) were compared with a control cohort (n= 579) of non-diabetic, non-PTI-receiving kidney transplant patients. We calculated hazard ratios (HR) with 95% confidence intervals (95% CI) for outcomes of first occurrence of solid or hematologic malignancy, non-melanoma skin cancer (NMSC) and post-transplant lymphoproliferative disorder (PTLD).ResultsOver a median follow-up of 5.7 years, PTI for GN was associated with significantly increased risk for malignancy compared with controls [13.0% vs 9.7%, respectively; adjusted HR 1.82 (95% CI 1.10–3.00)], but not for NMSC [10.3% vs 11.4%, respectively; adjusted HR 1.09 (95% CI 0.64–1.83)] or PTLD [3.3% vs 3.1%, respectively; adjusted HR 1.02 (95% CI 0.40–2.61)]. The risk for malignancy was significantly increased in those who received cyclophosphamide [HR 2.59 (95% CI 1.48–4.55)] or rituximab [HR 3.82 (95% CI 1.69–8.65)] pre-transplant, and particularly in those who received both cyclophosphamide and rituximab, but not for calcineurin inhibitors or mycophenolate.ConclusionThe use of PTI for treatment of GN, especially cyclophosphamide or even with rituximab, is associated with increased risk for development of solid or hematologic malignancy post-transplant. These data highlight potential risks with treatment of GN and underscore the importance of post-transplant malignancy surveillance in this patient population.