Artikel
De novo Bronchiogenic Malignancies following Kidney Transplantation – A Single Center Report
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Autoren
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Florian Augustin
- Univ.-Klinik für Chirurgie, Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck, Österreich
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Manuel Maglione
- Univ.-Klinik für Chirurgie, Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck, Österreich
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Claudia Bösmüller
- Univ.-Klinik für Chirurgie, Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck, Österreich
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Raimund Margreiter
- Univ.-Klinik für Chirurgie, Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck, Österreich
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Thomas Schmid
- Univ.-Klinik für Chirurgie, Visceral-, Transplantations- und Thoraxchirurgie, Innsbruck, Österreich
| Veröffentlicht: | 20. November 2009 |
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Gliederung
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Aims: Chronic immunosuppressive therapy (IS) implicates a higher risk for cancer development. In Europe, bronchial cancer (BC) is associated with the highest mortality rate compared to other malignancies. Aim of this study was to evaluate incidence and outcome of patients developing BC following kidney or simultaneous pancreas kidney (SPK) transplantation.
Methods: Patients, who have undergone SK or SPK transplantation at our institution between 1996 and 2008 and later on had developed BC, were analized retrospectively.
Results: Among 1641 patients, 10 (0.61%) developed BC. 2 patients had a SPK and 8 a kidney transplant alone; 2 patients were female. Median age at transplantation was 60 (range 39–72) years. 5 patients suffered from diabetic nephropathy, 3 from glomerulonephritis, 2 had nephrosclerosis. Prophylactic IS consisted of calcineurin-based (5 cyclosporine, 5 tacrolimus) triple drug therapy. Pretransplant chest X-rays were without abnormal findings, even retrospectively reviewed. 9 patients had a smoking history. Median interval from transplantation to tumor diagnosis was 36 (range 7–149) months. In 9 patients (90%), carcinomas were diagnosed at UICC stage IV (1 Small Cell Lung Cancer, 8 Non Small Cell Lung Cancers). 6 patients were treated with palliative radio-chemotherapy; 3 patients received symptomatic therapy. The only carcinoma diagnosed at UICC stage IB was curatively resected; the patient is still alive without recurrent disease after a follow-up of 390 days. A second patient with recent diagnosis is alive with stable disease under polychemotherapy (Carboplatin/Taxotere/Cetuximab). All other patients suffered from progressive disease with a median survival of 7 (range 1–13) months.
Conclusion: The cumulative incidence (0.61%) of BC is higher when compared to a non immunosuppressed population. Nearly all tumors were already metastatic at diagnosis. Due to the poor prognosis, special screening strategies for patients waiting for organ transplantation with a smoking history should be considered.
