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目的对肾移植受者并发泌尿系统恶性肿瘤的情况进行分析,探讨其防治措施。方法回顾分析肾移植术后发生泌尿系统恶性肿瘤的44例患者的临床资料。44例受者的免疫抑制方案,11例为环孢素A(CsA)、霉酚酸酯及泼尼松(Pred)联用,1例采用CsA、咪唑立宾及Pred联用,1例采用他克莫司、咪唑立宾及Pred联用,其余采用CsA、硫唑嘌呤及Pred联用。结果44例的肿瘤诊断时间为移植后2～273个月,中位数为39.5个月,其中。肾细胞癌5例,双侧肾盂输尿管癌10例,单侧肾盂输尿管癌16例,输尿管癌1例,膀胱癌12例;共有8例出现淋巴结或远处转移。诊断肿瘤后,对免疫抑制方案进行调整,43例患者接受了手术治疗,1例由于诊断不及时,丧失手术机会。经过治疗,39例存活,5例死亡。结论肾移植术后恶性肿瘤尤其是泌尿系统恶性肿瘤的发生率明显升高,治疗的关键在于早期诊断、及时手术,并辅以免疫抑制方案的调整。
Objective To analyze the incidence of urinary malignancies in renal transplant recipients and to explore the preventive measures. Methods The clinical data of 44 patients with urinary malignancies after renal transplantation were retrospectively analyzed. Forty-four recipients received immunosuppressive regimens. Eleven of them received cyclosporin A (CsA), mycophenolate mofetil, and prednisone (Pred), one received CsA, Tacrolimus, mizoribine and Pred combination, the rest with CsA, azathioprine and Pred combination. Results The diagnosis of tumor in 44 cases was 2 ~ 273 months after transplantation, with a median of 39.5 months. 5 cases of renal cell carcinoma, bilateral ureteropelvic cancer in 10 cases, unilateral ureteropelvic cancer in 16 cases, ureteral carcinoma in 1 case, bladder cancer in 12 cases; a total of 8 cases of lymph node or distant metastasis. After diagnosis of the tumor, the immunosuppressive regimen was adjusted, 43 patients underwent surgery, and 1 had lost the chance of surgery due to an inadequate diagnosis. After treatment, 39 survived and 5 died. Conclusions The incidence of malignant tumors, especially urologic malignancies, after renal transplantation is significantly increased. The key to the treatment is early diagnosis and timely operation, supplemented by the adjustment of immunosuppressive regimens.