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Nonmelanoma Skin Cancers After Kidney Transplant: Our 15 Years of Experience With Mammalian Target of Rapamycin Inhibitors
- Source :
- Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 15(Suppl 1)
- Publication Year :
- 2017
-
Abstract
- We evaluated patients with nonmelanoma skin cancer after kidney transplant and the effects of immunosuppression reduction and switching to a mammalian target of rapamycin inhibitor drugs.Kidney transplant recipients were evaluated retrospectively from patient medical records (between January 2000 and December 2014). A 30% increase in serum creatinine was accepted as indicating renal failure progression.Of 18 patients included (mean follow-up 98 ± 66 mo), 7 (38.8%) had squamous cell carcinoma, 7 (38.8%) had Kaposi sarcoma, and 4 (22.2%) had basal cell carcinoma. At cancer diagnosis, average serum creatinine was 1.6 ± 0.7 mg/dL and proteinuria was 410 ± 766 mg/d. Immunosuppression regimen was changed in 15 patients (83.3%), with new regimen being a single-drug (only prednisolone) in 4 patients, double-drug in 6 patients, and triple-drug protocol in 8 patients. Eight patients were switched to a mammalian target of rapamycin inhibitor-based double (4 patients) or triple (4 patients) regimen. During follow-up after starting new treatment (average 46 ± 50 mo), 6 patients (33.3%) had progressive kidney failure (0 were receiving triple regimen). Those that progressed were using mammalian target of rapamycin inhibitor-based drugs relatively less (33% vs 50%), although often receiving a single-drug immunosuppression treatment (50% vs 8.3%). Three patients (33.3%) had acute rejection (2 receiving double and 1 receiving single immunosuppression treatment). Five patients (27.7%) had local recurrence of the primary tumor. Mammalian target of rapamycin inhibitor use was relatively less common in patients with tumor relapse (20% vs 46%). One patient died (heart failure), and 1 with chronic rejection returned to dialysis.Mammalian target of rapamycin inhibitorbased drugs could reduce local recurrence rate in kidney transplant recipients with nonmelanoma skin cancers. Aggressive reduction and/or cessation of immunosuppressive drugs after skin cancer can lead to graft rejection.
- Subjects :
- Graft Rejection
Skin Neoplasms
Time Factors
Drug Substitution
Cost-Benefit Analysis
TOR Serine-Threonine Kinases
Graft Survival
Kidney Transplantation
Drug Costs
Medical Records
Treatment Outcome
Carcinoma, Basal Cell
Risk Factors
Carcinoma, Squamous Cell
Humans
Neoplasm Recurrence, Local
Protein Kinase Inhibitors
Sarcoma, Kaposi
Immunosuppressive Agents
Retrospective Studies
Subjects
Details
- ISSN :
- 21468427
- Volume :
- 15
- Issue :
- Suppl 1
- Database :
- OpenAIRE
- Journal :
- Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation
- Accession number :
- edsair.pmid..........ace9acafd1cd2f87fee63cee2a0c3f24