腎移植術後產生癌症的風險分析

研究目的腎臟移植可以改善末期腎衰竭患者的生活品質，進一步提升病人的存活率。移植術後需長期使用免疫抑制劑以防止器官排斥，但也因此腎移植受者比一般民眾有較高的罹癌率。免疫抑制劑的過度使用可能是器官移植術後產生癌症的原因之一，帶狀疱疹病毒感染亦是腎移植術後常見的併發症之一，是否暗示著免疫抑制過度?本研究欲藉由病歷資料回顧分析：(一)腎移植術後產生癌症的風險因子(二)腎移植術後合併帶狀疱疹感染之患者是否具有較高的癌症發生率。研究方法及資料研究對象來自中部某醫學中心腎臟科門診規則追蹤的456位腎移植受者，藉由病歷回顧方式收集資料，以多元複迴歸分析：腎移植術後產生癌症的風險因素，以及腎移植術後合併帶狀疱疹感染之患者與癌症發生率上升之間是否具有關聯性。研究結果在456位腎移植受者中共有48(10.5)位罹患癌症，有27(56.3%)位罹患腎臟或泌尿系統腫瘤；有9(18.8%)位罹患肝細胞癌；有4(8.3%)位罹患大腸直腸癌；有3(6.3%)位罹患乳癌；肺癌則有2(4.2%)位；而食道癌、卡波西氏肉瘤、舌癌則分別各有1(2.1%)位。產生癌症的腎移植受者以女性移植者居多(64%)、年齡較大58.7±10.2 v.s 55.7±10.9歲(p=0.165)、空腹血糖值較低101.4±30.1 v.s 108.5±32.7 mg/dl (p=0.045)、移植後的平均腎功能較佳, 血清肌酐酸為1.36±0.38vs1.29±0.40 mg/dl (p=0.068)。較多患者使用Cyclosporine免疫抑制藥物。至於帶狀疱疹病毒感染與癌症發生率之間，不具有統計意義(p=0.715)。結論與建議本研究結果顯示腎移植術後產生癌症的種類以腎臟或泌尿系統癌症為首位，肝細胞癌次之，大腸直腸癌居第三位，與台北榮總的健保資料庫分析相似；但與歐美國家的統計資料相異。罹癌患者使用Cyclosporine的病人較多，可能與本院年長病患較常使用此藥有關。

BackgroundRenal transplantation improves life quality and survival rate in uremic patients. Chronic use of immunosuppressive agents or over-immunosupressionmay increase long-term risks of malignancy.We hypothesized herpes zoster infection maybe a status of over-immunosupression and we aimed to examine whether the kidney transplant recipients with herpes zoster infection were with increased risk of malignancy. MethodsA retrospective, single center and case-control study was conducted. A total of 456 kidney transplant recipients were enrolled. Clinical and laboratory data were collected by chart review. Multivariate logistic regression was applied to examine the long-term risk of malignancy followingrenal transplantation and the association between herpes zoster infection and malignancy. Results Among the 456 kidney transplant recipients, 48(10.5%) patients were with malignancy. Twenty-seven (56.3%) patients were with renal or urothelial malignancy, nine (18.8%) were with hepatocellular carcinoma, four (8.3%) were with colonorectal cancer, three (6.3%) were with breast cancer and two (4.2%) patients were with lung cancer. The other malignancy involved esophageal cancer (n=1, 2.1%), tongue cancer (n=1, 2.1%) and Kaposi sarcoma (n=1, 2.1%). The patients with malignancy were with more female (64%), older age 58.7±10.2 v.s 55.7±10.9 years (p=0.165), better fasting blood sugar 101.4±30.1 v.s 108.5±32.7 mg/dl (p=0.045), better serum creatinine1.36±0.38vs1.29±0.40 mg/dL(p=0.068), and more use with cyclosporine. Relationship between herpes zoster infection and post-transplant malignancy was insignificant (p=0.715)。ConclusionThe major malignancy after kidney transplantation in this study is renal or urothelialcarcinoma, followed by lung cancer and colon cancer. These results are similar to those from the survey of National Health Insurance database, but are different from the reports from America and Europe. The increased frequency in use of cyclosporine in patients with malignancy may be caused by our tendency of use of cyclosporine in older patients.