脑肿瘤供者供肾移植短期临床研究
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摘要
目的总结脑肿瘤供者供肾移植术后短期临床效果。方法回顾性分析2015年1月至2017年4月武汉大学人民医院器官移植科接受脑肿瘤供者供肾移植的27例受者临床资料。所有受者免疫诱导方案均为标准双剂巴利昔单抗,术后免疫抑制维持方案为吗替麦考酚酯(MMF)+他克莫司+泼尼松。术后定期随访,每次随访复查血常规、肝肾功能、电解质及他克莫司血药浓度,记录排斥反应及感染发生情况,同时定期监测是否发生肿瘤。结果截至2017年10月,所有受者随访6~36个月。27例受者中2例于移植术后1周发生移植肾功能延迟恢复,其中1例经治疗后无法逆转,最终恢复透析治疗;另外1例经治疗后肾功能逐渐恢复。1例受者于移植术后4个月发生肺部真菌感染,治疗无效后死于呼吸衰竭。2例受者分别于术后3、8个月发生排斥反应,经治疗后均好转。除1例因局灶性节段性肾小球硬化复发致移植肾失功及1例肺部感染导致死亡外,未出现其他原因导致的移植肾丢失。所有受者术后胸腹部影像学检查未见肿瘤相关疾病发生,移植肾每月至少进行1次彩色多普勒超声检查,未见占位性病变。结论脑肿瘤供者供肾移植后移植肾功能短期恢复良好。
Objective To summarize the short-term effects of kidney transplantation from the donors with brain tumor. Methods The clinical data of 27 recipients who got kidney transplantation from donors with brain tumor in department of organ transplantation of Renmin Hospital of Wuhan University from January 2015 to April 2017 were retrospectively analyzed. The immunosuppression induction therapy of the recipients was double standard reagents of basiliximab, and the immunosuppressive regimen after surgery was mycophenolate mofetil,tacrolimus and prednison. All the recipients were regularly followed up after operation,and with blood routine,hepatorenal function,plasma concentrations of tacrolimus test every time. What's more,the occurrence of rejection reaction,infection,tumor recurrence were monitored and recorded. Results All the recipients were followed-up for 6-36 months up to October 2017. Two recipients suffered from delayed graft function 1 week after operation,1 of them recovered after treatment,and another recipient recieved dialysis treatment again.One recipient got pulmonary infection 4 months after operation,but died of respiratory failure. Two recipients suffered from reject reaction 3 months and 8 months respectively after operation,and all improved after active treatment. All the recipients did not die except 1 recipient with focal segmental glomerulosclerosis and 1 recipient with pulmonary infection after operation. No tumor recurrence was found in any of the recipients. Conclusions The renal from the donor with brain tumor recover well in the short term after transplantation.
Objective To summarize the short-term effects of kidney transplantation from the donors with brain tumor. Methods The clinical data of 27 recipients who got kidney transplantation from donors with brain tumor in department of organ transplantation of Renmin Hospital of Wuhan University from January 2015 to April 2017 were retrospectively analyzed. The immunosuppression induction therapy of the recipients was double standard reagents of basiliximab, and the immunosuppressive regimen after surgery was mycophenolate mofetil,tacrolimus and prednison. All the recipients were regularly followed up after operation,and with blood routine,hepatorenal function,plasma concentrations of tacrolimus test every time. What's more,the occurrence of rejection reaction,infection,tumor recurrence were monitored and recorded. Results All the recipients were followed-up for 6-36 months up to October 2017. Two recipients suffered from delayed graft function 1 week after operation,1 of them recovered after treatment,and another recipient recieved dialysis treatment again.One recipient got pulmonary infection 4 months after operation,but died of respiratory failure. Two recipients suffered from reject reaction 3 months and 8 months respectively after operation,and all improved after active treatment. All the recipients did not die except 1 recipient with focal segmental glomerulosclerosis and 1 recipient with pulmonary infection after operation. No tumor recurrence was found in any of the recipients. Conclusions The renal from the donor with brain tumor recover well in the short term after transplantation.
引文
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2 Xiao D,Craig JC,Chapman JR,et al.Donor cancer transmission in kidney transplantation:a systematic review[J].Am J Transplant,2013,13(10):2645-2652.
3 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[J].Eur J Cancer,2013,49(2):336-344.
4 Solez K,Colvin RB,Racusen LC,et al.Banff 07 classification of renal allograft pathology:updates and future directions[J].Am J Transplant,2008,8(4):753-760.
5 牛斌,林静,陈晓瑜,等.肾移植术后新发恶性肿瘤临床分析[J].器官移植,2013,4(2):91-94.
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7 Pendón-Ruiz de Mier V,Navarro Cabello MD,Martínez Vaquera S,et al.Incidence and long-term prognosis of cancer after kidney transplantation[J].Transplant Proc,2015,47(9):2618-2621.
8 Kasiske BL,Snyder JJ,Gilbertson DT,et al.Cancer after kidney transplantation in the United States[J].Am J Transplant,2004,4(6):905-913.
9 Watson CJ,Roberts R,Wright KA,et al.How safe is it to transplant organs from deceased donors with primary intracranial malignancy?An analysis of UK registry data[J].Am J Transplant,2010,10(6):1437-1444.
10 Buell JF,Beebe TM,Trofe J,et al.Donors with central nervous system malignancies:are they truly safe?[J].Transplantation,2003,76(2):340-343.
11 Buell JF,Gross T,Alloway RR,et al.Central nervous system tumors in donors:misdiagnosis carries a high morbidity and mortality[J].Transplant Proc,2005,37(2):583-584.
12 Hassanain M.Novel guidelines for organ donor cancer screening[J].Ann Transplant,2014,19(19):241-247.
13 Desai R,Collett D,Watson CJ,et al.Cancer transmission from organ donors-unavoidable but low risk[J].Transplantation,2012,94(12):1200-1207.
14 Nalesnik MA,Woodle ES,Dimaio JM,et al.Donor-transmitted malignancies in organ transplantation:assessment of clinical risk[J].Am J Transplant,2011,11(6):1140-1147.
15 黄倩,王心强,蒋继贫,等.原发性中枢神经系统肿瘤供者供肾移植63例安全性分析[J].中华器官移植杂志,2017,38(3):136-139.
16 Zhang J,Ma L,Xie Z,et al.Epidemiology of post-transplant malignancy in Chinese renal transplant recipients:a single-center experienceand literature review[J].Med Oncol,2014,31(7):32.
17 俞能旺,郝俊文,刘贞,等.肾移植术后并发恶性肿瘤患者应用西罗莫司的经验[J].中华器官移植杂志,2015,36(6):373-374.
18 李新长,龙成美,杨华,等.肾移植术后新发恶性肿瘤17例临床分析[J/CD].中华移植杂志:电子版,2017,11(2):90-92.
19 蒋婉洁,卢一平.KDIGO临床实践指南:肾移植受者的诊治[J/CD].中华移植杂志:电子版,2010,4(2):156-164.
2 Xiao D,Craig JC,Chapman JR,et al.Donor cancer transmission in kidney transplantation:a systematic review[J].Am J Transplant,2013,13(10):2645-2652.
3 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[J].Eur J Cancer,2013,49(2):336-344.
4 Solez K,Colvin RB,Racusen LC,et al.Banff 07 classification of renal allograft pathology:updates and future directions[J].Am J Transplant,2008,8(4):753-760.
5 牛斌,林静,陈晓瑜,等.肾移植术后新发恶性肿瘤临床分析[J].器官移植,2013,4(2):91-94.
6 张健,马麟麟,解泽林,等.我国肾移植术后新发恶性肿瘤总结分析[J].中华器官移植杂志,2014,35(12):705-710.
7 Pendón-Ruiz de Mier V,Navarro Cabello MD,Martínez Vaquera S,et al.Incidence and long-term prognosis of cancer after kidney transplantation[J].Transplant Proc,2015,47(9):2618-2621.
8 Kasiske BL,Snyder JJ,Gilbertson DT,et al.Cancer after kidney transplantation in the United States[J].Am J Transplant,2004,4(6):905-913.
9 Watson CJ,Roberts R,Wright KA,et al.How safe is it to transplant organs from deceased donors with primary intracranial malignancy?An analysis of UK registry data[J].Am J Transplant,2010,10(6):1437-1444.
10 Buell JF,Beebe TM,Trofe J,et al.Donors with central nervous system malignancies:are they truly safe?[J].Transplantation,2003,76(2):340-343.
11 Buell JF,Gross T,Alloway RR,et al.Central nervous system tumors in donors:misdiagnosis carries a high morbidity and mortality[J].Transplant Proc,2005,37(2):583-584.
12 Hassanain M.Novel guidelines for organ donor cancer screening[J].Ann Transplant,2014,19(19):241-247.
13 Desai R,Collett D,Watson CJ,et al.Cancer transmission from organ donors-unavoidable but low risk[J].Transplantation,2012,94(12):1200-1207.
14 Nalesnik MA,Woodle ES,Dimaio JM,et al.Donor-transmitted malignancies in organ transplantation:assessment of clinical risk[J].Am J Transplant,2011,11(6):1140-1147.
15 黄倩,王心强,蒋继贫,等.原发性中枢神经系统肿瘤供者供肾移植63例安全性分析[J].中华器官移植杂志,2017,38(3):136-139.
16 Zhang J,Ma L,Xie Z,et al.Epidemiology of post-transplant malignancy in Chinese renal transplant recipients:a single-center experienceand literature review[J].Med Oncol,2014,31(7):32.
17 俞能旺,郝俊文,刘贞,等.肾移植术后并发恶性肿瘤患者应用西罗莫司的经验[J].中华器官移植杂志,2015,36(6):373-374.
18 李新长,龙成美,杨华,等.肾移植术后新发恶性肿瘤17例临床分析[J/CD].中华移植杂志:电子版,2017,11(2):90-92.
19 蒋婉洁,卢一平.KDIGO临床实践指南:肾移植受者的诊治[J/CD].中华移植杂志:电子版,2010,4(2):156-164.