Comparison of two strategies based on mammalian target of rapamycin inhibitors in secondary prevention of non-melanoma skin cancer after kidney transplantation, a pilot study.

Abstract

After kidney transplantation, withdrawal of calcineurin inhibitors (CNI) and conversion to sirolimus (SRL) may reduce the occurrence of new non-melanoma skin cancer (NMSC). Conversely, a reduced CNI exposure with everolimus (EVR) is an alternative strategy that has not been thoroughly evaluated. We retrospectively compared the occurrence of newly diagnosed NMSCs in two cohorts of kidney transplant recipients (KTR) with at least one NMSC: 35 patients were converted to EVR with reduced CNI exposure (CNI/EVR group), whereas 46 patients were converted to SRL in association with mycophenolic acid (MPA) (SRL/MPA group). Two years after conversion, survival free of new NMSC was similar between the two cohorts (p = .37), with 19 KTR (54.3%) in the CNI/EVR group and 22 (47.8%) in the SRL/MPA group being diagnosed of at least one new NMSC. Half of the KTR from both groups showed adverse events, leading to mTORi discontinuation for 37.1% of KTR in the CNI/EVR group and 21.7% in the SRL/MPA group (p = .09). The incidence of rejections was similar between the two groups. In a retrospective cohort of KTR with at least one post-transplant NMSC, the outcome of the patients converted to a CNI/EVR regimen was not different from those converted to a SRL/MPA regimen.

• Authors: Julie Préterre, Jonathan Visentin, Morgane Saint Cricq, Hannah Kaminski, Arnaud Del Bello, Mathilde Prezelin-Reydit, Pierre Merville, Nassim Kamar, Lionel Couzi
• Journal: Clinical transplantation (Clin Transplant) Vol. 35 Issue 3 Pg. e14207 (03 2021) ISSN: 1399-0012 [Electronic] Denmark
• PMID: 33369772 (Publication Type: Journal Article)
• Copyright: © 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Calcineurin Inhibitors
• Immunosuppressive Agents
• TOR Serine-Threonine Kinases
• Mycophenolic Acid
• Sirolimus

Topics

• Calcineurin Inhibitors
• Graft Rejection (etiology, prevention & control)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Kidney Transplantation (adverse effects)
• Mycophenolic Acid
• Pilot Projects
• Retrospective Studies
• Secondary Prevention
• Sirolimus (therapeutic use)
• Skin Neoplasms (etiology, prevention & control)
• TOR Serine-Threonine Kinases