Abstract
Amaç: Böbrek nakli alıcıları, genel popülasyona kıyasla yüksek kanser riski altındadır. Nakil sonrası kanserin prognozu kötüdür ve immünosüpresyonun nasıl yönetileceğine dair veriler azdır. Bu çalışmada, merkezimizde takip edilen böbrek nakli alıcılarında kanser gelişimi insidansı ve kanser türlerinin greft ve hasta sağkalımına etkisinin değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: 2000 ve 2019 yılları arasında böbrek nakli yapılan 628 hasta retrospektif olarak incelenmiş ve nakil sonrası kanser tanısı alan 33 hastanın (%5,26) demografik verileri, nakil ve kanser özellikleri, greft ve hasta sağkalımları değerlendirilmiştir.
Bulgular: Ortalama kanser tanı yaşı 48 idi. Kanser dağılımı sırasıyla solid organ tümörleri (%57,6), melanom dışı deri kanserleri (%24,2) ve posttransplant lenfoproliferatif hastalık (%18,2) şeklindeydi. Nakil sonrası kanser tanısına kadar geçen süre 66 aydı. Hastaların %45,5’inde kanser tanısı sonrası immünosüpresif tedavi azaltımı ve %54,5’inde mTOR (Rapamisin memeli hedefi) inhibitörlerine geçiş yapılmıştı. Tanı sonrası immünosüpresif tedavi redüksiyonu posttransplant lenfoproliferatif hastalıkta hastalarının tamamı kemoterapi almıştı ve %83,3’ünde immünosüpresyon azaltılmıştı. Diğer kanser türlerinde bu oranlar anlamlı olarak daha azdı (sırasıyla, p=0,010 ve p=0,032). Hastaların 4’ünde (%12,1) greft kaybı, 13’ünde (%39,4) ölüm izlendi. İmmünosüpresyon azaltımı greft sağkalımı ile ilişkili değildi. Posttransplant lenfoproliferatif hastalıkta kanser teşhisi sonrası ölüm oranı diğer kanserlere göre daha yüksek (p=0,049) ve hasta sağkalım süresi daha kısaydı(p=0,006).
Sonuç: Böbrek nakli alıcılarında kanser önemli bir mortalite sebebidir ve çalışmamızda posttransplant lenfoproliferatif hastalıkta hasta sağkalımı diğer kanser türlerine göre daha düşüktür. Hastaların nakil sonrası kanser gelişimi açısından yaşı ve risk faktörlerine uygun kanser taramalarının düzenli yapılması önemlidir. İmmünosüpresif tedavilerin yönetimi için randomize kontrollü çalışmalara ihtiyaç vardır.
Keywords
Ethical Statement
Çalışma için Ankara Üniversitesi Tıp Fakültesi İnsan Araştırmaları Etik Kurulu’ndan onay alındı (karar tarihi: 02/11/2023, karar no: İ09-653-23).
Supporting Institution
-
Project Number
-
Thanks
-
References
- 1. Au E, Wong G, Chapman JR. Cancer in kidney transplant recipients. Nat Revn Nephrol. 2018;14:508-520.
- 2. Kumru G. Böbrek Nakli ve Kanser. Güngör Ö, Koçyiğit İ, Temiz G, editörler. Onko-Nefroloji. Ankara: Nobel Tıp Kitabevi. 2023; s.127-137.
- 3. Webster AC, Craig JC, Simpson JM, et al. Identifying high risk groups and quantifying absolute risk of cancer after kidney transplantation: a cohort study of 15,183 recipients. Am J Transplant. 2007;7:2140-2151.
- 4. Wong G, Turner RM, Chapman JR, et al. Time on dialysis and cancer risk after kidney transplantation. Transplantation. 2013;95:114-121.
- 5. Acuna SA, Huang JW, Daly C, et al. Outcomes of Solid Organ Transplant Recipients With Preexisting Malignancies in Remission: A Systematic Review and Meta-Analysis. Transplantation. 2017;101:471-481.
- 6. Sprangers B, Nair V, Launay-Vacher V, et al. Risk factors associated with post-kidney transplant malignancies: an article from the Cancer-Kidney International Network. Clin Kidney J. 2018;11:315-329.
- 7. Piselli P, Serraino D, Segoloni GP, et al. Risk of de novo cancers after transplantation: results from a cohort of 7217 kidney transplant recipients, Italy 1997-2009. Eur J Cancer. 2013;49:336-344
- 8. Benoni H, Eloranta S, Dahle DO, et al. Relative and absolute cancer risks among Nordic kidney transplant recipients-a population-based study. Transpl Int. 2020;33:1700-1710.
- 9. Al-Adra D, Al-Qaoud T, Fowler K, et al. De Novo Malignancies after Kidney Transplantation. Clin J Am Soc Nephrol. 2022;17:434-443.
- 10. Vogelzang JL, Van Stralen KJ, Noordzij M, et al. Mortality from infections and malignancies in patients treated with renal replacement therapy: data from the ERA-EDTA registry. Nephrol Dial Transplant. 2015;30:1028-1037.
- 11. D’Arcy ME, Coghill AE, Lynch CF, et al. Survival after a cancer diagnosis among solid organ transplant recipients in the United States. Cancer. 2019;125:933-942.
- 12. Güngör M, Kumru G, Eren Sadioğlu R, et al. Relationship Between Posttransplant Proteinuria and Renal Graft Outcomes: A Single Center Experience. 17. BANTAO Congress; 10-13 November, 2022; Antalya, Turkey. s. 30. OP-27.
- 13. Au EH, Chapman JR, Craig JC, et al. Overall and Site-Specific Cancer Mortality in Patients on Dialysis and after Kidney Transplant. J Am Soc Nephrol. 2019;30:471-480.
- 14. Yang D, Thamcharoen N, Cardarelli F. Management of Immunosuppression in Kidney Transplant Recipients Who Develop Malignancy. J Clin Med. 2019;8:2189.
- 15. Hellemans R, Pengel LHM, Choquet S, et al. Managing immunosuppressive therapy in potentially cured post-kidney transplant cancer (excluding nonmelanoma skin cancer): an overview of the available evidence and guidance for shared decision-making. Transpl Int. 2021;34:1789-1800.
- 16. Knoll GA, Kokolo MB, Mallick R, et al. Effect of sirolimus on malignancy and survival after kidney transplantation: systematic review and meta-analysis of individual patient data. BMJ. 2014;349:g6679.
- 17. Yanik EL, Siddiqui K, Engels EA. Sirolimus effects on cancer incidence after kidney transplantation: a meta-analysis. Cancer Med. 2015;4:1448-1459.
- 18. Opelz G, Unterrainer C, Süsal C, et al. Immunosuppression with mammalian target of rapamycin inhibitor and incidence of post-transplant cancer in kidney transplant recipients. Nephrol Dial Transplant. 2016;31:1360-1367.
- 19. Romagnoli J, Tagliaferri L, Acampora A, et al. Management of the kidney transplant patient with Cancer: Report from a Multidisciplinary Consensus Conference. Transplant Rev (Orlando). 2021;35:100636.
Clinical Characteristics and Survival of Kidney Transplant Recipients with Posttransplant Malignancy
Abstract
Objectives: Kidney transplant recipients are at increased risk of malignancy compared to the general population. The prognosis of posttransplant malignancy is poor, and data on how to manage immunosuppression are scarce. This study aimed to evaluate posttransplant malignancy incidence and its effects on graft and patient survival in kidney transplant recipients.
Materials and Methods: Six hundred and twenty-eight patients who underwent kidney transplantation between 2000 and 2019 were retrospectively examined. Demographic data, transplant and cancer characteristics, graft and patient survival of 33 patients (5.26%) diagnosed posttransplant malignancy were evaluated.
Results: The average age at malignancy diagnosis was 48 years. Malignancy distribution was as follows: solid organ tumors (57.6%), non-melanoma skin cancers (24.2%) and posttransplant lymphoproliferative disease (18.2%). The time from transplantation to malignancy diagnosis was 66 months.Immunosuppression was reduced in 45.5% of the patients and 54.5% had switched to mammalian target of rapamycin inhibitors. In posttransplant lymphoproliferative disease, all patients received chemotherapy and immunosuppression was reduced in 83.3%. These rates were significantly lower
Keywords
Ethical Statement
Çalışma için Ankara Üniversitesi Tıp Fakültesi İnsan Araştırmaları Etik Kurulu’ndan onay alındı (karar tarihi: 02/11/2023, karar no: İ09-653-23).
Supporting Institution
-
Project Number
-
Thanks
-
References
- 1. Au E, Wong G, Chapman JR. Cancer in kidney transplant recipients. Nat Revn Nephrol. 2018;14:508-520.
- 2. Kumru G. Böbrek Nakli ve Kanser. Güngör Ö, Koçyiğit İ, Temiz G, editörler. Onko-Nefroloji. Ankara: Nobel Tıp Kitabevi. 2023; s.127-137.
- 3. Webster AC, Craig JC, Simpson JM, et al. Identifying high risk groups and quantifying absolute risk of cancer after kidney transplantation: a cohort study of 15,183 recipients. Am J Transplant. 2007;7:2140-2151.
- 4. Wong G, Turner RM, Chapman JR, et al. Time on dialysis and cancer risk after kidney transplantation. Transplantation. 2013;95:114-121.
- 5. Acuna SA, Huang JW, Daly C, et al. Outcomes of Solid Organ Transplant Recipients With Preexisting Malignancies in Remission: A Systematic Review and Meta-Analysis. Transplantation. 2017;101:471-481.
- 6. Sprangers B, Nair V, Launay-Vacher V, et al. Risk factors associated with post-kidney transplant malignancies: an article from the Cancer-Kidney International Network. Clin Kidney J. 2018;11:315-329.
- 7. Piselli P, Serraino D, Segoloni GP, et al. Risk of de novo cancers after transplantation: results from a cohort of 7217 kidney transplant recipients, Italy 1997-2009. Eur J Cancer. 2013;49:336-344
- 8. Benoni H, Eloranta S, Dahle DO, et al. Relative and absolute cancer risks among Nordic kidney transplant recipients-a population-based study. Transpl Int. 2020;33:1700-1710.
- 9. Al-Adra D, Al-Qaoud T, Fowler K, et al. De Novo Malignancies after Kidney Transplantation. Clin J Am Soc Nephrol. 2022;17:434-443.
- 10. Vogelzang JL, Van Stralen KJ, Noordzij M, et al. Mortality from infections and malignancies in patients treated with renal replacement therapy: data from the ERA-EDTA registry. Nephrol Dial Transplant. 2015;30:1028-1037.
- 11. D’Arcy ME, Coghill AE, Lynch CF, et al. Survival after a cancer diagnosis among solid organ transplant recipients in the United States. Cancer. 2019;125:933-942.
- 12. Güngör M, Kumru G, Eren Sadioğlu R, et al. Relationship Between Posttransplant Proteinuria and Renal Graft Outcomes: A Single Center Experience. 17. BANTAO Congress; 10-13 November, 2022; Antalya, Turkey. s. 30. OP-27.
- 13. Au EH, Chapman JR, Craig JC, et al. Overall and Site-Specific Cancer Mortality in Patients on Dialysis and after Kidney Transplant. J Am Soc Nephrol. 2019;30:471-480.
- 14. Yang D, Thamcharoen N, Cardarelli F. Management of Immunosuppression in Kidney Transplant Recipients Who Develop Malignancy. J Clin Med. 2019;8:2189.
- 15. Hellemans R, Pengel LHM, Choquet S, et al. Managing immunosuppressive therapy in potentially cured post-kidney transplant cancer (excluding nonmelanoma skin cancer): an overview of the available evidence and guidance for shared decision-making. Transpl Int. 2021;34:1789-1800.
- 16. Knoll GA, Kokolo MB, Mallick R, et al. Effect of sirolimus on malignancy and survival after kidney transplantation: systematic review and meta-analysis of individual patient data. BMJ. 2014;349:g6679.
- 17. Yanik EL, Siddiqui K, Engels EA. Sirolimus effects on cancer incidence after kidney transplantation: a meta-analysis. Cancer Med. 2015;4:1448-1459.
- 18. Opelz G, Unterrainer C, Süsal C, et al. Immunosuppression with mammalian target of rapamycin inhibitor and incidence of post-transplant cancer in kidney transplant recipients. Nephrol Dial Transplant. 2016;31:1360-1367.
- 19. Romagnoli J, Tagliaferri L, Acampora A, et al. Management of the kidney transplant patient with Cancer: Report from a Multidisciplinary Consensus Conference. Transplant Rev (Orlando). 2021;35:100636.
Details
| Primary Language | English |
|---|---|
| Subjects | Nefroloji |
| Journal Section | Articles |
| Authors | |
| Project Number | - |
| Publication Date | March 28, 2024 |
| Submission Date | November 14, 2023 |
| Acceptance Date | November 18, 2023 |
| Published in Issue | Year 2024 Volume: 77 Issue: 1 |
