Buradasınız

Böbrek Naklinden Sonra Malignite Gelişimi: Tek Merkez Deneyimi

Malignancy After Renal Transplantation: A Single-Center Experience

Journal Name:

Publication Year:

Abstract (2. Language): 
Aim: The aim of present the study was to evaluate development of malignancy in the renal transplant recipients who were followed up from 05.05.1994 to 31.01.2008 in Erciyes University Faculty of Medicine. Material and Method: The patients with post-transplant malig¬nancy among the 123 renal transplant recipients were included in the study. Results: The donor source was living donor in 77 (62.6%) and cadaver donor in the rest of them. The mean age was 32.3±7.6 (range 17-65) years. Lymphoma and skin cancer were detected in four and three renal transplant recipients, respectively. Also two female patients developed ovary and cervix carcinoma. All patients with lymphoma received chemotherapy. These patients with skin, ovary, and cervix cancer were operated. In all patients with post-transplant malignancy, the dose of immunosuppressive drugs were reduced or modified after treatment of malignancy. Two patients with lymphoma died due to infection. The other patients with post-transplant malignancy have been followed-up with functional graft and complete remission. Conclusion: The malignancies developed more frequently than normal population after renal transplantation. The post-trans¬plant malignancies were lymphomas and skin and gynecological cancers.
Abstract (Original Language): 
Amaç: Bu çalışmada Erciyes Üniversitesi Tıp Fakültesi'nde 05.05.1994 ile 31.01.2008 tarihleri arasında takip edilen böbrek nakli yapılmış hastalarda malignite gelişiminin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Böbrek nakli yapılmış 123 hasta arasında malignite saptananlar çalışmaya alındı. Bulgular: Böbrek verici kaynağı 77 (%62.6) olguda canlı, 46 (%37.4) olguda ise kadavraydı. Hastaların yaşları 17 ile 65 yaş arasında değişmekteydi ve ortalama yaş 32.3 ± 7.6 yıldı. Nakil sonrası 9 (%7.3) olguda malignite gelişti. Malignite gelişen bu dokuz olgunun dördünde lenfoma, üçünde cilt kanseri, birer hastada ise over ve serviks kanseri saptandı. Lenfoma gelişen olgulara kemoterapi verildi. Cilt, over ve serviks kanseri gözlenen olgular ise opere edildi. Daha sonra bu olguların immunsupresif ilaçlarının dozları azaltıldı ya da başka bir immunsupresif ilaç ile değiştirildi. Nakil sonrası malignite gelişen olgulardan lenfomalı iki hasta enfeksiyona bağlı kaybedilirken, diğer hastalar fonksiyone greft ve tam remisyon ile takip edilmektedir. Sonuç: Böbrek naklinden sonra malignite gelişimi genel po-pülasyona göre daha sık olarak gözlenmiştir. Gelişen bu maligni-teler ise lenfoma, cilt kanserleri ve jinekolojik kanserler olarak saptanmıştır.
113-118

REFERENCES

References: 

1. Suthanthiran M, Strom TB. Renal transplantation. N Engl J Med 1994;331:365-376.
2. Wolfe RA, Ashby VB, Milfort EL, et al. Comparison of morta¬lity in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant.
N Engl J Med 1999;341:1725-1730.
3. Rubin RH. Infectious disease complications of renal trans¬plantation. Kidney Int 1993;44:221-236.
4. Agraharkar ML, Cinclair RD, Kuo YF, Daller JA, Shahinian VB. Risk of malignancy with long-term immunosuppression in renal transplant recipients. Kidney Int 2004;66:383-389.
5. Saeian K, Franco J, Komorowski RA, Adams MB. Hepatocel-lular carcinoma after renal transplantation in the absence of cirrhosis or viral hepatitis: A case series. Liver Transpl Surg 2003;5:46-49.
6. Garnier JL, Lebranchu Y, Dantal J, et al. Hodgkin's disease af¬ter transplantation. Transplantation 1996;61:71-76.
7. Andreone P, Gramenzi A, Lorenzini S, et al. Posttransplanta-tion lymphoproliferative disorders. Arch Intern Med
2003;163:1997-2004.
8. Penn I. Why do immunosuppressed patients develop cancer? In: Pimentel E (Eds), Critical Reviews in Oncogenesis. CRC,
Boca Raton 1989; p: 27-29.
Official Journal of the Turkish Society of Nephrology / Türk Nefroloji Diyaliz ve Transplantasyon Dergisi
117
0 Malignancy After Renal Transplantation: A Single-Center Experience
9. Ducloux D, Carron PL, Rebibou JM, et al. CD4 lymphocyto-penia as a risk factor for skin cancers in renal transplant re¬cipients. Transplantation 1998;65:1270-1272.
10. Opelz G, Henderson R. Incidence of non-Hodgkin lympho-ma in kidney and heart transplant recipients. Lancet
1993;342:1514-1516.
11. Taylor DO, Edwards LB, Boucek MM, et al. Registry of the
International Society for Heart and Lung transplantation: twenty-second official adult heart transplant report—2005. J
Heart Lung Transplant 2005;24:945-955.
12. Penn I. Malignant melanoma in organ allograft recipients.
Transplantation 1996;61:274-278.
13. Kauffman HM, McBride MA, Delmonico FL. First report of the United Network for Organ Sharing Transplant Tumor Re¬gistry Donors with a history of cancer. Transplantation
2000;70:1747-1751.
14. Cheung AN, Chan AC, Chung LP, et al. Post-transplantation lymphoproliferative disorder of donor origin in a sex-mis¬matched renal allograft as proven by chromosome in situ
hybridization. Mod Pathol 1998;11:99-102.
15. Denton MD, Magee CC, Ovuvorie C, et al. Prevalence of re¬nal cell carcinoma in patients with ESRD pre-transplantatiton: a pathologic analysis. Kidney Int 2002;61:2201-2209.
16. Penn I. De novo malignances in pediatric organ transplant recipients. Pediatr Transplant 1998;2:56-63.
17. Webb MC, Compton F, Andrews PA, Koffman CG. Skin tu¬mors posttransplantation: a retrospective analysis of 28 years experience at a single centre. Transplant Proc 1997;29: 828¬830.
18. Euvrard S, Kanitakis J, Pouteil-Noble C, et al. Comparative epidemiologic study of premalignant and malignant epitheli¬al cutaneous lesions developing after kidney and heart trans¬plantation. J Am Acad Dermatol 1995;33:222-229.
19. Pedotti P, Cardillo M, Rossini G, Arcuri V, et al. Incidence of cancer after kidney transplant: Results from the North Italy transplant program. Transplantation 2003;76: 1448-1451.
20. Cooper SM, Wojnarowska F. The accuracy of clinical diagno¬sis of suspected premalignant and malignant skin lesions in re¬nal transplant recipients. Clin Exp Dermatol 2002;27:436-438.
21. Shihab FS, Bennett WM, Isaac J, et al. Nitric oxide modulates vascular endothelial growth factor and receptors in chronic cyclosporine nephrotoxicity. Kidney Int 2003; 63:522-533.
22. Mathew T, Kreis H, Friend P. Two-year incidence of malig¬nancy in sirolimus-treated renal transplant recipients: results from five multicenter studies. Clin Transplant 2004;18:446-449.
23. Campistol JM, Gutierrez-Dalmau A, Torregrosa JV. Conversi¬on to sirolimus: a successful treatment for posttransplantati-on Kaposi's sarcoma. Transplantation 2004; 77:760-762.
24. Dantal J, Soulillou JP. Immunosuppressive drugs and the risk of cancer after organ transplantation. N Engl J Med
2005;352:1371-1373.
25. Swinnen LJ, Costanzo-Nordin MR, Fisher SG, et al. Increased incidence of lymphoproliferative disorder after immunosup-pression with the monoclonal antibody OKT3 in cardiac-
transplant recipients. N Engl J Med 1990;323:1723-1728.
26. Duman S, Toz H, Aşcı G, et al. Successful treatment of post-transplant Kaposi's sarcoma by reduction of immunosuppres-
sion. Nephrol Dial Transplant 2002;17:892-896.
27. Rook AH, Jaworsky C, Nguyen T, et al. Beneficial effect of low-dose systematic retinoid in combination with topical tre-tinoin fort he treatment and prophylaxis of premalignant and malignant skin lesions in renal transplant recipients. Trans¬plantation 1995;59:714-719.
28. Adami J, Gabel H, Lindelof B, et al. Cancer risk following or¬gan transplantation: a nationwide cohort study in Sweden. Br
J Cancer 2003;89:1221-7.
29. Penn I. Cancers complicating organ transplantation. N Engl J
Med 1990;323:1767-9.
30. Cockfield SM. Identifying the patient at risk for post-trans¬plant lymphoproliferative disorder. Transpl Infect Dis
2001;3.70-78.
31. Smith JM, Rudser K, Gillen D, et al. Risk of lymphoma after re¬nal transplantation varies with time: An analysis of the United States Renal Data System. Transplantation 2006;81:175-180.
32. Aris RM, Maia DM, Neuringer IP, et al. Post-transplantation lymphoproliferative disorder in the Epstein-Barr virus-naive lung transplant recipient. Am J Respir Crit Care Med
1996;154:1712-1717.
33. Moosa MR. Kaposi's sarcoma in kidney transplant recipients: a 23-year experience. QJM 2005;98:205-214.
34. Buell JF, Gross TG, Woodle ES. Malignancy after transplanta¬tion. Transplantation 2005;80:S254-264.
35. Guba M, Graeb C, Jauch KW, Geissler EK. Pro- and anti-can¬cer effects of immunosuppressive agents used in organ trans¬plantation. Transplantation 2004;77: 1777-1782.
36. Opelz G, Döhler B. Lymphomas after solid organ transplan¬tation: a collaborative transplant study report. Am J Trans¬plant 2004;4:222-230.
37. Tsai DE, Hardy CL, Tomaszewski JE, et al. Reduction in im-munosuppression as initial therapy for posttransplant lymphoproliferative disorder : Analysis of prognostic variab¬les and long-term follow-up of 42 adult patients. Transplan¬tation 2001;71:1076-1088.
38. Starzl TE, Nalesnik MA, Porter KA, et al. Reversibility of lymphomas and lymphoproliferative lesions developing un¬der cyclosporin-steroid therapy. Lancet 1984;1:583-587.
39. Rees L, Thomas A, Amlot PL. Disappearance of an Epstein-Barr virus-positive post-transplant plasmacytoma with reduc¬tion of immunosuppression. Lancet 1998;352:78-91.
40. Gross TG, Bucuvalas JC, Park JR, et al. Low-dose chemothe¬rapy for Epstein-Barr virus-posivite post-transplantation lymphoproliferative disease in children after solid organ transplantation. J Clin Oncol 2005;23:6481-6488.
41. Schoch OD, Boehler A, Speich R, Nestle FO. Extracorporeal photochemotherapy for Epstein-Barr virus-associated lymphoma after lung transplantation. Transplantation l999;68:1056-1058.
42. Pham PTT, Wilkinson AH, Gritsch HA, et al. Monotherapy with the anti-CD20 monoclonal antibody rituximab in a kid¬ney transplant recipient with posttransplant lymphoprolifera-tive disease. Transplant Proc 2002;34:1178-1181.

Thank you for copying data from http://www.arastirmax.com