Potent immunosuppression for ABO-incompatible renal transplantation may not be a risk factor for malignancy.
ABO-incompatible (ABOi) renal transplantation has been increasing, but malignant tumor is a troubling complication of kidney transplantation due to potent immunosuppression. Few previous studies, however, have demonstrated that potent immunosuppression for ABOi living-donor renal transplantation (LDRT) is a risk factor for malignancy. In the present research, data on 252 LDRT patients ftom 2003 to 2008 were retrospectively analyzed to clarify whether ABOi LDRT was associated with malignancy. A potent immunosuppressive regimen for ABOiLDRT consisted of splenectomy, cyclophosphamide, and double-filtration plasmapheresis to minimize the risk of antibody-mediated rejection, in addition to conventional immunosuppresssants including calcineurin inhibitor, prednisolone, and anti-CD25 monoclonal antibody. A total of 11 incidences of malignancy were observed during a median follow-up of 48 months. The incidence rates in ABO-compatible (ABOc; n = 189) and ABOi (n = 63) LDRT groups were 4.2 % (8/189) and 4.8 % (3/63), respectively. Kaplan-Meier survival analysis showed no statistical difference in event-free survival for malignancy between ABOc and ABOiLDRT groups (log-rank P = .73). Multivariable Cox regression analyses identified no associations of malignancy with ABOi LDRT or any immunosuppressant use. In conclusion, our investigation suggested that potent immunosuppression with splenectomy and cyclophosphamide for ABOi LDRT may not be a risk factor for malignancy.
Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan. tyamamoto@med.nagoya-u.ac.jp
T
T
Yamamoto
T
T
Kawaguchi
Y
Y
Watarai
M
M
Tujita
T
T
Hiramitsu
K
K
Nanmoku
N
N
Goto
A
A
Katayama
T
T
Kobayashi
K
K
Uchida
D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D001787:Blood Group Incompatibility / Q000276:immunology* / Q000401:mortality; D016009:Chi-Square Distribution; D003888:Desensitization, Immunologic / Q000009:adverse effects* / Q000401:mortality; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006648:Histocompatibility; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007564:Japan; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000276:immunology* / Q000401:mortality; D010956:Plasmapheresis / Q000009:adverse effects; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013156:Splenectomy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents