Malignancies in renal transplant recipients

Završni stadij kronične bubrežne bolesti zahtijeva liječenje nadomještanjem bubrežne funkcije različitim metodama, od kojih je najbolja transplantacija bubrega, zbog značajno više stope preživljavanja i kvalitete života u usporedbi s dijalizom. U početcima transplantacijske medicine, kada su transplantacije izvođene samo u mlađih pacijenata, a preživljenje presatka bilo relativno kratko zbog visoke stope akutnih odbacivanja, zloćudni tumori predstavljali su manje važan problem. Vodeći uzrok gubitka presatka u vrijeme suvremene imunosupresije je smrt pacijenata s funkcionirajućim presatkom, a upravo su zloćudni tumori, nakon srčanožilnih bolesti i infekcija, na trećem mjestu uzročnika smrti u populaciji pacijenata s transplantacijom koja je sve starija i pod sve dužim kumulativnim djelovanjem imunosupresiva. Prema podatcima Registra za transplantaciju Australije i Novog Zelanda 10 % pacijenata razvije tumor nakon 10 godina, 25 % nakon 20 godina, a nakon 30 godina čak 40 % primatelja bubrega pod imunosupresivnom terapijom razvije tumor. U kohorti od 175 000 primatelja u Sjedinjenim Američkim Državama je identificirano 10 656 tumora, što je 2,1 puta više nego u općoj populaciji. Uočen je značajan porast rizika za više od 30 različitih primarnih tumora te snižena incidencija tumora dojke i prostate u odnosu na opću populaciju.End-stage renal disease requires the replacement of kidney function by different methods, the best of them being renal transplantation owing to significant survival advantage and better quality of life compared to the dialysis. In the beginnings of transplantation medicine, when transplantation was performed solely in young patients, and survival was relatively short due to acute rejections, malignant tumors were not a significant problem. In the era of modern immunosuppression, the leading cause of graft lost is death of a patient with functional graft. Malignant tumors are the third leading cause of death in patients following renal transplantation due to the increasing age of patients undergoing renal transplantation and longer cumulative influence of immunosuppression. Cardiovascular diseases and infections are the first and a second leading cause of death, respectively. According to Australian and New Zealand Dialysis and Transplant Registry, 10% of patients develop tumor 10 years after transplantation, 25% after 20 years, and after 30 years 40% of renal transplant recipients treated with immunosuppression develop malignancy. In a large population-based cohort study of 175 000 United States transplant recipients of solid organs, among those 10 656 developed some kind of a tumor. This is 2.1 times more often when compared to the general population. A significant increase of risk for 30 different primary tumors was reported, whereas a decreased incidence of breast cancer and prostate cancer was noted