停用降钙素抑制剂可降低酒精相关肝病肝移植后新发恶性肿瘤的风险

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-11-17 DOI:10.1111/ctr.70014

Domitille Erard, Anouk Steiner, Olivier Boillot, Elsa Thimonier, Mélanie Vallin, Florian Veyre, Olivier Guillaud, Sylvie Radenne, Jérôme Dumortier

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引用次数: 0

摘要

背景：新发恶性肿瘤是肝移植（LT）后死亡的主要原因之一，尤其是因酒精相关肝病（ALD）而接受移植的患者。这项回顾性研究旨在评估恶性肿瘤的风险因素，并评估停用钙神经蛋白抑制剂（CNI）的影响：方法：纳入1990年至2015年所有因ALD而接受移植的患者：结果：共纳入493例患者，其中77.9%为男性，LT时的中位年龄为54岁。LT后，214名患者（43.4%）确诊为278例新发恶性肿瘤。新发恶性肿瘤的累积发病率分别为：5年16.3%，10年34.4%，15年49.8%。在多变量分析中，男性（HR = 1.6）、吸烟或已戒烟（HR = 2.0）是独立的风险因素。停用 CNI 是一个保护因素（HR = 0.6）。诊断为新发恶性肿瘤后，5年存活率为42.7%，10年存活率为27.5%：我们的研究结果证实了ALD接受LT治疗后新发恶性肿瘤的主要发病率，以及吸烟和性别等不可改变的风险因素的重要作用。停用氯化萘类药物是一种保护性因素，也是唯一一种适应性强的因素，建议用于因ALD而接受移植的吸烟男性患者。

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Calcineurin-Inhibitor Discontinuation Could Reduce the Risk of De Novo Malignancies After Liver Transplantation for Alcohol-Related Liver Disease

Background

De novo malignancies are one of the leading causes of death after liver transplantation (LT), particularly in patients transplanted for alcohol-related liver disease (ALD). This retrospective study aimed to assess risk factors for malignancies and to evaluate the impact of calcineurin inhibitor (CNI) discontinuation.

Methods

From 1990 to 2015, all patients transplanted for ALD were included.

Results

A total of 493 patients were included, 77.9% were male and the median age at LT was 54 years. After LT, 278 de novo malignancies were diagnosed in 214 patients (43.4%). The cumulative incidence of de novo malignancies was 16.3% at 5 years, 34.4% at 10 years, and 49.8% at 15 years. In multivariate analysis, the independent risk factors were male gender (HR = 1.6), and active or weaned smoking (HR = 2.0). Discontinuation of CNI was a protective factor (HR = 0.6). Survival after diagnosis of de novo malignancy was 42.7% at 5 years and 27.5% at 10 years.

Conclusion

Our results confirm the major incidence of de novo malignancies after LT for ALD, as well as the important role of non-modifiable risk factors such as smoking and gender. CNI discontinuation is a protective factor, and the only adaptable, and could be proposed in smoker male patients transplanted for ALD.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.