Palabras clave
neoplasias postrasplante
cáncer cutáneo no melanoma
sarcoma de Kaposi
trastornos linfoproliferativos postrasplante
enfermedad renal crónica
Cómo citar
Resumen
Contexto: el trasplante renal (TxR) es la mejor alternativa de terapia de reemplazo renal (TRR) para pacientes con enfermedad renal crónica (ERC) estadio 5; sin embargo, conlleva un mayor riesgo de desarrollar neoplasias, las cuales representan la tercera causa de morbimortalidad en esta población, después de las infecciones y las enfermedades cardiovasculares. La incidencia de neoplasias en receptores de trasplante renal es aproximadamente 10 veces mayor que en la población general y se asocia a un perfil más agresivo. La literatura internacional reporta tasas de incidencia de entre 3,9?% y 14,9?%, y las principales neoplasias asociadas al TxR son el cáncer cutáneo no melanoma (CCNM), el sarcoma de Kaposi (SK) y los trastornos linfoproliferativos postrasplante (PTLD, según sus siglas en inglés), siendo el carcinoma de cérvix una posible asociación adicional.
Objetivo: describir la incidencia, la distribución y las características de las neoplasias desarrolladas en una cohorte colombiana de pacientes con trasplante renal durante un seguimiento de 30 años.
Metodología: estudio observacional retrospectivo de 4572 receptores de trasplante renal entre 1993 y 2023. Se analizaron variables clínicas y oncológicas mediante frecuencias, porcentajes y medias o medianas según distribución. Se usaron pruebas t de Student o U de Mann-Whitney, chi-cuadrado o exacta de Fisher. La supervivencia libre de neoplasia se estimó con curvas de Kaplan-Meier y prueba de log-rank. Se consideró significancia estadística con p <0,05.
Resultados: se identificaron 278 neoplasias, con una incidencia global del 6,0?%. El carcinoma espinocelular representó el 24,4?% de los casos, el carcinoma basocelular el 20,5?%, los PTLD el 11,5?%, el SK el 9?% y el carcinoma de cérvix el 8,3?%. Estas cinco entidades constituyeron el 73,7?% del total de neoplasias, mientras que el 26,3?% restante correspondió a tumores no asociados clásicamente al trasplante, como cáncer de próstata, vejiga, estómago, colon, tiroides, mama y tumor renal de células claras. Las neoplasias como SK, PTLD y carcinoma de cérvix presentaron una aparición temprana (dentro de los primeros 60 meses postrasplante), mientras que el CCNM fue de aparición tardía. La mediana del tiempo entre el trasplante y el diagnóstico de neoplasia fue de 56 meses (RIC?=?24-93).
Conclusiones: las neoplasias postrasplante renal son frecuentes, con un comportamiento clínico agresivo y un alto impacto en la calidad de vida del paciente y la sobrevida del injerto. Nuestros hallazgos refuerzan la necesidad de implementar estrategias integrales de tamizaje, prevención y manejo oncológico en esta población, con un enfoque multidisciplinario y adaptado al contexto local.
Citas
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