Novel association between graft rejection and post-transplant malignancy in solid organ transplantation  

作　　者：Hye Sung Kim Wongi Woo Young-Geun Choi Ankit Bharat Young Kwang Chae 

机构地区：[1]Department of Medicine,Temple University Hospital,Philadelphia,PA 19140,United States [2]Department of Medicine,St.Joseph Medical Center,Stockton,CA 95204,United States [3]Department of Mathematics Education,Sungkyunkwan University,Seoul 03063,South Korea [4]Department of Surgery,Northwestern University Feinberg School of Medicine,Chicago,IL 60611,United States [5]Department of Medicine,Robert H.Lurie Comprehensive Cancer Center of Northwestern University,Chicago,IL 60611,United States

出　　处：《World Journal of Transplantation》2025年第2期179-196,共18页世界移植杂志(英文)

摘　　要：BACKGROUND Advancements in immunosuppressive therapies have improved graft survival by enhancing graft tolerance and preventing organ rejection.However,the risk of malignancy associated with prolonged immunosuppression remains a concern,as it can adversely affect recipients’quality of life and survival.While the link be-tween immunosuppression and increased cancer risk is well-documented,the specific interactions between graft rejection and post-transplant malignancy(PTM)remain poorly understood.Addressing this knowledge gap is crucial for devising immunosuppressive strategies that balance rejection prevention with cancer risk reduction.AIM To investigate whether immunosuppression in PTM reduces rejection risk,while immune activation during rejection protects against malignancy.METHODS We analyzed data from the United Network for Organ Sharing’s Organ Procurewith no prior history of malignancy(in donors or recipients).Landmark analyses at 1,2,3,5,10,15,and 20 years post-transplant,Kaplan–Meier analyses,and time-dependent Cox proportional hazards regression models,each incorporating the temporal dimension of outcomes,assessed the association between rejection-induced graft failure(RGF)and PTM.Multivariate models were adjusted for clinical and immunological factors,including immunosuppression regimens.RESULTS The cohort included 579905 recipients(kidney:386878;liver:108390;heart:45046;lung:37643;pancreas:1948)with a mean follow-up of 7.3 years and a median age of 50.6±13.2 years.RGF was associated with a reduction in PTM risk across all time points[hazard ratio(HR)=0.07-0.20,P<0.001],even after excluding mortality cases.Kidney transplant recipients exhibited the most pronounced reduction(HR=0.22,P<0.001).Conversely,among recipients with PTM,RGF risk decreased across all time points up to 15 years after excluding mortality cases(HR=0.49–0.80,P<0.001).This risk reduction was observed in kidney,liver,heart,and lung transplants(HRs=0.90,0.21,0.21,and 0.18,respectively;P<0.001)but not in pancreas transplants.CO

关 键 词：Graft rejection Post-transplant malignancy TRANSPLANTATION Transplant immunology IMMUNOSUPPRESSION Kidney transplant Liver transplant Heart transplant Lung transplant Pancreas transplant 

分 类 号：R617[医药卫生—外科学] R587.1[医药卫生—临床医学]