Böbrek nakli sonrasında görülen malignitelerin retrospektif analizi
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Date
2020
Authors
Çelik, Seda
Journal Title
Journal ISSN
Volume Title
Publisher
Bursa Uludağ Üniversitesi
Abstract
Çalışmamızda nakil sonrası malignite gelişen hastaların özelliklerinin ve risk faktörlerinin retrospektif olarak incelenmesi, graft ve hasta sağkalımı üzerine etkilerinin araştırılması amaçlanmıştır. Bursa Uludağ Üniversitesi Tıp Fakültesi Hastanesi Transplantasyon Merkezinde Mart 1998-Mayıs 2019 tarihleri arasında canlı veya kadaverik vericiden böbrek nakli yapılan 667 hasta retrospektif olarak incelenmiştir. 667 nakil hastasından 40’ında (%6) malignite saptanmıştır. En sık gözlenen kanser türleri ise cilt kanseri (%2.4), renal hücreli kanser (%0.6), tiroid kanseri (%0.6), lenfoma (%0.6) ve meme kanseri (%0.4) olarak bulunmuştur. Ülkemizdeki 2011-2015 yılları arasındaki genel popülasyondaki kanser insidansıyla, merkezimizdeki nakil hastalarının 5 yıllık malignite insidans ortalaması karşılaştırıldığında; erkeklerde tüm kanserler 6.5 kat, kadınlarda ise tüm kanserler 1.6 kat artmış olarak bulunmuştur. Cilt, renal hücreli kanser, tiroid kanseri ve lenfoma insidansı genel popülasyona göre belirgin derecede artış göstermiştir. Nakil sonrası sirolimus + takrolimus + kortikosteroid kombinasyonu kullanımı malignite riskinde azalma ile ilişkiliyken (p=0.023), yaş artışı ve nakil yaşının fazla olması ise malignite riskinde artışla ilişkili bulunmuştur (p<0.001). Sonuç olarak böbrek nakil hastalarında genel popülasyona oranla malignite riskinde artış saptanmıştır. Bu nedenle solid organ malignitelerini, özellikle erken evre karsinomları önlemek ve tespit etmek için hastaların kılavuzlara uygun şekilde taranması gerekmektedir.
In our study, it was aimed to retrospectively examine the characteristics and risk factors of patients developing post-transplant malignancy and to investigate the effects on graft and patient survival. 667 patients who underwent kidney transplantation from live or cadaveric donors between March 1998 and May 2019 at Bursa Uludağ University Medical Faculty Hospital Transplantation Center were retrospectively analyzed. Malignancy was detected in 40 (6%) of 667 transplant patients. The most common types of cancer are skin cancer (2.4%), renal cell cancer (0.6%), thyroid cancer (0.6%), lymphoma (0.6%) and breast cancer (0.4%). When the cancer incidence in the general population between 2011-2015 in our country and the 5-year malignancy incidence average of the transplant patients in our center were compared; all cancers in men were found to be 6.5-fold and all cancers in women were increased by 1.6-fold. The incidence of skin, renal cell cancer, thyroid cancer and lymphoma has increased significantly compared to the general population. In our study, the use of the combination of sirolimus + tacrolimus + corticosteroid after transplantation was associated with a decrease in the risk of malignancy (p=0.023), while the increase in age and transplantation age was associated with an increase in the risk of malignancy (p<0.001). As a result, an increased risk of malignancy was observed in kidney transplant patients compared to the general population.Therefore, patients should be screened in accordance with the guidelines in order to prevent and detect solid organ malignancies, especially early stage carcinomas.
In our study, it was aimed to retrospectively examine the characteristics and risk factors of patients developing post-transplant malignancy and to investigate the effects on graft and patient survival. 667 patients who underwent kidney transplantation from live or cadaveric donors between March 1998 and May 2019 at Bursa Uludağ University Medical Faculty Hospital Transplantation Center were retrospectively analyzed. Malignancy was detected in 40 (6%) of 667 transplant patients. The most common types of cancer are skin cancer (2.4%), renal cell cancer (0.6%), thyroid cancer (0.6%), lymphoma (0.6%) and breast cancer (0.4%). When the cancer incidence in the general population between 2011-2015 in our country and the 5-year malignancy incidence average of the transplant patients in our center were compared; all cancers in men were found to be 6.5-fold and all cancers in women were increased by 1.6-fold. The incidence of skin, renal cell cancer, thyroid cancer and lymphoma has increased significantly compared to the general population. In our study, the use of the combination of sirolimus + tacrolimus + corticosteroid after transplantation was associated with a decrease in the risk of malignancy (p=0.023), while the increase in age and transplantation age was associated with an increase in the risk of malignancy (p<0.001). As a result, an increased risk of malignancy was observed in kidney transplant patients compared to the general population.Therefore, patients should be screened in accordance with the guidelines in order to prevent and detect solid organ malignancies, especially early stage carcinomas.
Description
Keywords
Böbrek nakli, İmmünsüpresyon, Malignite, Kidney transplant, Immunosuppression, Malignancy
Citation
Çelik, S. (2020). Böbrek nakli sonrasında görülen malignitelerin retrospektif analizi. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.