Der Nephrologe

, Volume 2, Issue 3, pp 182–188 | Cite as

Tumorerkrankungen nach Nierentransplantation

Leitthema
  • 39 Downloads

Zusammenfassung

Tumorerkrankungen nach Nierentransplantation stellen klinisch ein hochrelevantes diagnostisches und therapeutisches Problem dar. Hautumoren, Lymphome und urogenitale Tumoren treten besonders gehäuft auf, und die Krankheitsverläufe dieser Tumoren, wie auch die anderer Malignome in diesem Kollektiv, sind häufig schwerwiegend und aggressiv. Die zur Abstoßungsverhütung notwendige Immunsuppression trägt wesentlich zur Tumortransformation bei, wobei sich sowohl die Dosis als auch der differenzierte Einsatz der verfügbaren Substanzen auf die Tumorinzidenz auswirken. Die Transplantationsnachsorge muss der Tumorfrüherkennung somit einen äußerst hohen Stellenwert einräumen.

Schlüsselwörter

Posttransplantationslymphom Immunsuppressiva Hauttumoren Nierentransplantation Transplantationsnachsorge 

Malignant disease following kidney transplantation

Abstract

Malignancies after transplantation pose a highly relevant diagnostic and therapeutic problem in clinical practice. The frequency of skin tumours, lymphomas and urogenital neoplasms is especially high, and the course of these neoplasms, like that of other malignancies in this patient group, is frequently very severe and aggressive. The immunosuppression necessary to prevent rejection contributes to the incidence of malignant transformation. These effects are dose dependent and are also affected by selective use of different immunosuppressive agents. In the surveillance following a kidney transplant, early tumour detection must therefore be given an extremely high priority.

Keywords

Posttransplant lymphoma Immunosuppressants Skin tumours Kidney transplantation Aftertreatment following transplant 

Notes

Interessenkonflikt

Als Gegenstand möglicher Interessenkonflikte könnten angesehen werden: Vortragshonorare der Firmen Roche, Novartis, Wyeth und Fujisawa. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

Literatur

  1. 1.
    Morath C, Mueller M, Goldschmidt H et al. (2004) Malignancy in renal transplantation. J Am Soc Nephrol 15: 1582–1588CrossRefPubMedGoogle Scholar
  2. 2.
    Buell JF, Gross TG, Woodle ES (2005) Malignancy after transplantation. Transplantation 80: S264–S264CrossRefGoogle Scholar
  3. 3.
    Kauffmann HM, Cherikh WS, McBride MA et al. (2006) Post-transplant de nove malignancies in renal transplant recipients: the past and present. Tranplant Int 19: 607–620CrossRefGoogle Scholar
  4. 4.
    Dreno B (2003) Skin cancers after transplantation. Nephrol Dial Transplant 18: 1052–1058CrossRefPubMedGoogle Scholar
  5. 5.
    Jemec GBE, Holm EA (2003) Nonmelanoma skin cancer in organ transplant patients. Transplantation 75: 253–257CrossRefPubMedGoogle Scholar
  6. 6.
    Oertel SH, Verschuuren E, Reinke P et al. (2005) Effect of anti-CD20-antibody rituximab in patients with post-transplant lymphoproliferative disorder (PTLD). Am J Transplant 5: 2901–2906CrossRefPubMedGoogle Scholar
  7. 7.
    Gardiner SJ, Begg EJ (2006) Pharmacogenetics, drug-metabolizing enzymes, and clinical practice. Pharmacol Rev 58: 521–590CrossRefPubMedGoogle Scholar
  8. 8.
    Penn I, Brunson ME (1988) Cancers after Ciclosporine therapy. Transplant Proc 20: 885–887Google Scholar
  9. 9.
    Marcen R, Pascual J, Tato AM et al. (2003) Influence of immunosuppression on the prevalence of cancer after kidney transplantation. Transplant Proc 35: 1714–1716CrossRefPubMedGoogle Scholar
  10. 10.
    Hiesse C, Rieu P, Kriaa F et al. (1997) Malignancy after renal transplantation: analysis of incidence and risk factors in 1700 patients followed during a 25-year period. Transplant Proc 29: 831–834CrossRefPubMedGoogle Scholar
  11. 11.
    Opelz G, Dohler B (2004) Lymphomas after solid organ transplantation: a collaborative transplant study report. Am J Transplant 4: 222–230CrossRefPubMedGoogle Scholar
  12. 12.
    Robson R, Cecka JM, Opelz G et al. (2005) Prospective registry-based observational cohort study of the long-term risk of malignancies in renal transplant patients treated with mycophenolate mofetil. Am J Transplant 5: 2954–2960CrossRefPubMedGoogle Scholar
  13. 13.
    Guba M, Breitenbuch P von, Steinbauer M et al. (2002) Rapamycin inhibits primary and metastatic tumor growth by antiangiogenesis: involvement of vascular endothelial growth factor. Nat Med 8: 128–135CrossRefPubMedGoogle Scholar
  14. 14.
    Luan FL, Ding R, Sharma VK et al. (2003) Rapamycin is an effective inhibitor of human renal cancer metastasis. Kidney Int 63: 917–926CrossRefPubMedGoogle Scholar
  15. 15.
    Majeswki M, Korecka M, Kossev P et al. (2000) The immunosuppressive macrolide RAD inhibits growth of human Epstein-Barr virus-transformed B lymphocytes in vitro and in vivo: A potential approach to prevention and treatment of posttransplant lymphoproliferative disorders. Proc Natl Acad Sci U S A 97: 4285–4290CrossRefPubMedGoogle Scholar
  16. 16.
    Stallone G, Schena A, Infante B et al. (2005) Sirolimus for Kaposi’s sarcoma in renal-transplant recipients. N Engl J Med 352: 1317–1323CrossRefPubMedGoogle Scholar
  17. 17.
    Opelz G, Naujokat C, Daniels V et al. (2006) Disassociation between risk of graft loss and risk of non-Hodgkin lymphoma with induction agents in renal transplant recipients. Transplantation 81: 1227–1233CrossRefPubMedGoogle Scholar
  18. 18.
    Ekberg H, Tedesco-Silva H, Demirbas A et al. (2006) Symphony – comparing standard immunosuppression to low-dose cyclosporine, tacrolimus and sirolimus in combination with MMF, daclizumab and corticosteroids in renal transplantation. Presented at the ATC congress on July 24, 2006Google Scholar
  19. 19.
    Howard RJ, Patton PR, Reed AI et al. (2002) The changing causes of graft loss and death after kidney transplantation. Transplantation 73: 1923–1928CrossRefPubMedGoogle Scholar
  20. 20.
    Chapman J, Webster AC (2004) Cancer report: ANZDATA registry 2004 report: 99Google Scholar

Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Nephrologische KlinikKlinikum CoburgCoburgDeutschland

Personalised recommendations