Abstract:

Objective The aim of this study was to investigate the risk factors，clinical features and prophylaxis of de novo cancers after liver transplantation. Methods Clinical data of 8 patients with the digestivesystem malignant tumor out of 1 809 patients who underwent liver transplantation and these patients who received complete follow-up in the First Central Hospital of Tianjin from January 2006 to January 2013 were analyzedretrospectively. Smoking and alcohol history，protopathy，blood concentration，prophylaxis of de novo cancers，diagnosis process and prognosis were summarized. Results The incidence of malignancies in digestive system after liver transplantation in our hospital was 0.44%（8/1 809），including 3 cases of colon cancer，2 cases of gastric cancer，2 cases of liver cancer，1 cases of esophageal cancer. The dosage of FK506 was reduced when patientsreceived the corresponding treatment when they had been diagnosed as malignancies. Up to the date of submission，8 patients were followed up for 3-62 months，the median time was 18.5 months and the fatality rate was 50%，bothdied of tumor progression and multiple organ failure. Conclusion Immunosuppression，primary disease，drinking and smoking history，age and virus infection may be high risk factors of malignancy following liver transplantation. The reduction of immunosuppression to the lowest level compatible with good allograft function and prophylactic measuresagainst certain viral infections is the most important preventive measure.

摘要：

目的 研究肝移植术后新发消化系统恶性肿瘤患者的临床特点、诊治经过、预防措施及预后。方法 回顾性分析 2006 年 1 月至 2013 年 1 月在天津市第一中心医院行肝移植术并接受完整随访的 1 809 例中 8 例新发消化系统恶性肿瘤患者的临床资料。总结患者的烟酒史、原发病、血药浓度、新发消化系统恶性肿瘤类型、诊治经过及预后等临床资料。结果 肝移植术后新发消化系统恶性肿瘤的发生率为 0.44%（8/1 809），其中结肠癌 3 例，胃癌 2 例，肝癌 2 例，食管癌 1 例。在患者确诊新发消化系统恶性肿瘤后， 减少他克莫司（FK506）用药量，并根据病情接受相应的治疗手段。8 例患者的随访时间为 3 ～ 62 个月，中位时间为 18.5 个月，病死率为 50%，均死于肿瘤进展和多器官功能衰竭。结论 免疫抑制剂、烟酒史及年龄可能是肝移植术后新发消化系统恶性肿瘤发生的高危因素。在保证移植肝功能正常和有效预防感染的前提下，尽可能减少免疫制剂用量，是预防肝移植术后新发消化系统恶性肿瘤发生的最重要措施。