De novo злокачественные новообразования после трансплантации печени: эпидемиология, факторы риска и стратегии ведения

Введение. Трансплантация печени существенно улучшает выживаемость пациентов с терминальными заболеваниями печени, однако сопровождается риском развития de novo злокачественных новообразований. Иммуносупрессия, вирусные инфекции и вредные привычки повышают риск онкологических осложнений в посттрансплантационном периоде.

Цель: обобщить современные данные о распространенности, факторах риска, диагностике, профилактике и лечении de novo злокачественных новообразований у реципиентов печени.

Материалы и методы. Представлен обзор литературных источников, включающих ретроспективные и проспективные исследования, метаанализы и гайдлайны, опубликованные за последние два десятилетия.

Результаты. Наиболее часто встречаются немеланомные опухоли кожи, посттрансплантационные лимфопролиферативные заболевания и солидные опухоли. Основными факторами риска являются хроническая иммуносупрессия, вирусные инфекции, курение, алкоголь, пожилой возраст и первичное заболевание печени. Современные подходы к лечению включают редукцию иммуносупрессии, хирургическое удаление, химиотерапию и таргетную терапию. mTOR-ингибиторы демонстрируют эффективность у части пациентов, особенно при саркоме Капоши и лимфопролиферативных заболеваниях.

Заключение. Учитывая высокий онкологический риск, необходимо проведение стратифицированных скрининговых программ и индивидуализированное ведение пациентов после трансплантации печени. Снижение дозы иммуносупрессии, модификация образа жизни и своевременная диагностика позволяют улучшить отдаленный прогноз.

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