Acute Rejection, T-Cell-Depleting Antibodies, and Cancer After Transplantation
Acute Rejection, T-Cell-Depleting Antibodies, and Cancer After Transplantation
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DOI：
10.1097/01.tp.0000442773.38510.32
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发表时间：
2014-04-27
期刊：
影响因子：
6.2
通讯作者：
Wong, Germaine
中科院分区：
文献类型：
--
作者：
Lim, Wai H.;Turner, Robin M.;Wong, Germaine
背景：全身性炎症反应在肿瘤的发生、发展中起重要作用。急性排斥反应是一种全身性炎症状态，可能是移植后肿瘤发展的共同偶然途径。免疫抑制治疗急性排斥反应的负担增加，特别是T细胞耗竭抗体的使用，可能会进一步增加癌症发生的风险。我们的目的是确定肾移植后急性排斥反应、T细胞耗竭抗体的使用与癌症风险之间的关系。方法使用澳大利亚和新西兰透析和移植登记(ANZDATA)，我们利用调整的COX比例风险和竞争风险模型对经历过T细胞耗竭抗体分层的患者的癌症发生风险进行评估。结果1997至2009年间共有7153例肾移植受者。共有467名受者(6.5%)患上癌症。与未发生急性排斥反应的受者相比，发生急性排斥反应并接受T细胞耗竭抗体治疗的受者患癌症的风险增加了1.4倍(调整后的危险比[HR]1.42，95%可信区间1.02-1.99，P=0.039)。与未发生急性排斥反应的受者相比，发生排斥反应需要T细胞耗竭抗体的受者发生泌尿生殖道癌的风险较高(HR2.20，95%CI1.33~3.66，P=0.007)。结论急性排斥需要T细胞耗竭抗体是肾移植受者发生癌症的重要危险因素，与年龄、心血管死亡等相互竞争的事件无关。
Background Systemic inflammatory response has been shown to play a vital role in carcinogenesis and tumor progression. Acute rejection is a systemic inflammatory state and may share a common casual pathway for cancer development after transplantation. The increased burden of immunosuppression used in the treatment of acute rejection, particularly the use of T-cell-depleting antibody may further heighten the risk of cancer development. We aimed to determine the association between acute rejection, T-cell-depleting antibody use and cancer risk after kidney transplantation.Methods Using the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA), we assessed the risk of incident cancer among those who had experienced rejection stratified by the use of T-cell-depleting antibody using adjusted Cox proportional hazard and competing risk models.Results A total of 7153 kidney transplant recipients between 1997 and 2009 were included. A total of 467 (6.5%) recipients developed cancers. Recipients who experienced acute rejection and treated with T-cell-depleting antibody were at a 1.4-fold increased risk of cancer (adjusted hazard ratio [HR] 1.42, 95% CI 1.02-1.99, P=0.039) compared with those who did not experience acute rejection. There was an excess risk of genitourinary tract cancers among recipients who had experienced rejection requiring T-cell-depleting antibody compared with recipients who did not experience acute rejection (HR 2.20, 95% CI 1.33-3.66, P=0.007).Conclusion Acute rejection requiring T-cell-depleting antibody is a significant risk factor for cancer development in kidney transplant recipients independent of competing events such as age and cardiovascular deaths.