目的：本研究探討臺灣末期腎臟病接受腎臟移植後罹患癌症及死亡的情形，並進一步探討境內及境外腎臟移植對末期腎臟病病患移植後罹患癌症及死亡的風險。
方法：本研究資料來源為國家衛生研究院全民健保資料庫。以1997年至2009年間所有接受腎臟移植的病患為研究對象，其中境外腎臟移植病患2096人，境內腎臟移植病患1627人。以傾向因素配對法將境內、境外兩組做1：1配對後，境內及境外兩組各有1075人。再以Cox 比例涉險模式作罹癌及死亡風險分析，並探討其影響因素。
結果：配對後共156人罹患癌症，境外腎臟移植罹癌率大於境內腎臟移植(8.74% vs. 5.77% ; p =0.008 )。不論是境外或境內腎臟移植，術後罹癌的種類均以腎臟癌、膀胱癌和肝癌為主。控制相關變項後，以境內移植作參考組，境外移植的罹癌風險為其1.68倍( 95% CI =1.21-2.33)。其他顯著相關變項有移植前透析時間愈長罹癌風險愈低，以透析時間小於1年為參考組，透析時間大於5年者罹癌風險為其0.16倍(95% CI =0.09-0.29)。有高血壓罹癌風險並未較高( HR=0.63; 95% CI =0.44-0.89)；有心血管疾病罹癌風險也較低(HR=0.53; 95% CI =0.30-0.94)；有慢性肝炎罹癌風險則較高(HR=2.08; 95% CI=1.48-2.92)
。在死亡相關風險部分，雖然境外移植罹癌後死亡風險較高，但是未達統計上顯著差異( p>0.05)。
結論：本研究顯示境外腎臟移植後罹癌風險大於境內腎臟移植，而境外移植的死亡風險並未大於境內移植。此結果可作為未來腎臟移植後照護之參考。
Objective: This study investigated the risk of cancer and mortality of end-stage renal disease (ESRD) after kidney transplantation in Taiwan. We also compared post-transplant cancer and mortality risk between overseas and domestic kidney transplantation.
Methods: 3723 patients received kidney transplantation from 1997 to 2009 were identified from the Taiwanese National Health Insurance Database. Among them, 2096 patients received overseas kidney transplantation and 1627 received domestic kidney transplantation. Propensity score matching method was used to reduce selection bias of patients between overseas and domestic groups. After 1:1 matching, 1075 patients who received overseas kidney transplantation and 1075 patients who received domestic kidney transplantation were included in the study. A Cox proportional hazard model was used to examine the risk of cancer and mortality after kidney transplantation.
Results: 156 patients got cancer after kidney transplantation. The incidence of cancer was higher in the overseas group than in the domestic group (8.74% vs. 5.77% ; p=0.008). The most common types of cancer after transplantation were kidney cancer, bladder cancer and liver cancer. The overseas group had a 1.68-fold (95% CI = 1.21-2.33) higher risk of post-transplant cancer than the domestic group. A trend of an increased risk of cancer was found in patients with shorter time of dialysis before transplantation. Other significant variables included hypertension (HR=0.63; 95% CI =0.44-0.89), cardiovascular disease (HR=0.53;95CI% =0.30-0.94), chronic hepatitis (HR=2.08; 95CI% CI =1.48-2.92). This risk of mortality was higher in the overseas group but did not reach statistical significance (p>0.05).
Conclusion: The post-transplant cancer risk is higher in the overseas group. There are no significant difference of mortality risk between overseas and domestic group.
