| Abstract | U početcima transplantacijske medicine glavne komplikacije transplantacije bubrega bile su akutno odbacivanje presatka te teške infekcije u primatelja dok je razvoj malignih bolesti predstavljao manji problem. Uvođenjem novih, modernih imunosupresivnih lijekova, u kombinaciji sa unaprijeđenjem kirurških tehnika kao i tehnika prezerviranja organa, došlo je do značajnog napretka u preživljenju presatka, a samim time i pacijenata. Međutim, dugotrajna terapija imunosupresivnim lijekovima istodobno je i jedan od glavnih čimbenika koji su u transplantiranih pacijenata doveli do znatnog povećanja incidencije malignih bolesti. Uspoređujući ukupnu učestalost malignih bolesti u primatelja transplantiranog bubrega s osobama podudarnima po dobi i spolu iz opće populacije vidljiv je porast od dva do četiri puta čime su maligne bolesti postale treći po redu uzrok smrtnosti u transplantiranih pacijenata, nakon kardiovaskularnih bolesti i infekcija. Porast incidencije uvelike ovisi o vrsti karcinoma te do najvećeg porasta incidencije dolazi kod Kaposijeva sarkoma, nemelanomskoga raka kože, karcinoma usne, posttransplantacijskih limfoproliferativnih poremećaja te anogenitalnog karcinoma. Iako se imunosupresija smatra glavnim čimbenikom koji dovodi do povećanja incidencije malignih bolesti u transplantiranih pacijenata, postoje i razni drugi faktori koji imaju svoj doprinos, a među njih ubrajamo infekcije onkogenim virusima, spol i dob, etnicitet, transplantacijske i imunogene faktore, prethodne karcinome, akutne epizode odbacivanja itd. Zbog povećanog rizika od pojave karcinoma u populaciji s transplantiranim bubregom potrebno je uvesti metode probira donora i primatelja prije transplantacije, probir i dijagnostičke metode nakon transplantacije, izbjegavati prekomjernu imunosupresivnu terapiju kao i modificirati imunosupresivnu terapiju u slučaju dijagnoze karcinoma, sve sa svrhom smanjenja rizika od pojave odnosno od mortaliteta malignih bolesti. |
| Abstract (english) | In the early days of transplantation medicine, the main complications of kidney transplantation were acute graft rejections and severe infections in the recipient, while the development of malignant diseases was a minor problem. With the introduction of new, modern immunosuppressive drugs, in combination with the improvement of surgical techniques as well as organ preservation techniques, there has been significant progress in the survival of transplants, and thus of patients. However, long-term therapy with immunosuppressive drugs is at the same time one of the main factors that led to a significant increase in the incidence of malignant diseases in transplant patients. Comparing the total frequency of malignant diseases in kidney transplant recipients with age- and sex-matched people from the general population, a two- to fourfold increase is visible, making malignant diseases the third leading cause of death in transplant patients, after cardiovascular diseases and infections. The increase in incidence largely depends on the type of cancer, and the greatest increase occurs in Kaposi's sarcoma, non-melanoma skin cancer, oral cancer, post-transplantation lymphoproliferative disorders and anogenital cancer. Although immunosuppression is considered the main factor that leads to an increase in the incidence of malignant diseases in transplant recipients, there are also various other factors that have their own influence, among which we include infections with oncogenic viruses, gender and age, ethnicity, transplantation and immunogenic factors, previous cancers, acute episodes of rejection, etc. Due to the increased risk of cancer in kidney transplant recipients, it is necessary to introduce screening methods for donors and recipients before transplantation, screening and diagnostic methods after transplantation, avoid excessive immunosuppressive therapy, as well as modify immunosuppressive therapy in the event of a cancer diagnosis, all with the purpose of reducing the risk of occurrence and mortality of malignant diseases. |
