Caroti L, Zanazzi M, Paudice N, Tsalouchos A, Carta P, Larti A, Pimpinelli N, Moscarelli L, Salvadori M, Bertoni E
Renal Unit, AOU Careggi, Florence, Italy.
Transplant Proc. 2012 Sep;44(7):1926-7. doi: 10.1016/j.transproceed.2012.06.035.
Squamous cell carcinoma of the skin (SCC) is the most frequent cancer in renal transplant recipients. Conversion to mammalian target of rapamycin inhibitors after diagnosis of SCC may reduce the incidence of recurrence of skin cancer. This retrospective study evaluated the outcome of renal transplant recipients followed by the Renal Unit with posttransplant diagnosis of SCC treated with conversion from calcineurin inhibitors (CNIs) to Everolimus (EVR) associated with low-dose cyclosporine. Eleven patients developed SCC at a median time from renal transplantation of 107 months (range 36-264). Five patients with creatinine clearance (CCl) below 40 mL/min before conversion developed end stage renal disease (two cases) or further deterioration of renal function (two cases); only one patient in this group maintained a stable renal function. The remaining six patients with a CC1 greater than 40 mL/min and proteinuria below 0.8 g/24 hours maintained a stable renal function after conversion to EVR at a median follow-up of 22 months (range 15-75). Conversion from CNIs to EVR has been proven safe, effective, and associated with low recurrence of SCC in patients with a CCl >40 mL/min. In the case of preexisting deterioration of renal function or significant proteinuria, conversion to EVR should be carefully evaluated.
皮肤鳞状细胞癌（SCC）是肾移植受者中最常见的癌症。SCC诊断后转换为雷帕霉素靶蛋白抑制剂可能会降低皮肤癌复发率。这项回顾性研究评估了肾内科对肾移植受者的随访结果，这些受者在移植后被诊断为SCC，并接受了从钙调神经磷酸酶抑制剂（CNIs）转换为依维莫司（EVR）并联合低剂量环孢素的治疗。11例患者在肾移植后中位时间107个月（范围36 - 264个月）发生了SCC。转换前肌酐清除率（CCl）低于40 mL/min的5例患者发展为终末期肾病（2例）或肾功能进一步恶化（2例）；该组中只有1例患者肾功能保持稳定。其余6例CCl大于40 mL/min且蛋白尿低于0.8 g/24小时的患者在转换为EVR后，中位随访22个月（范围15 - 75个月）肾功能保持稳定。对于CCl>40 mL/min的患者，从CNIs转换为EVR已被证明是安全、有效的，且SCC复发率低。对于已存在肾功能恶化或大量蛋白尿的情况，转换为EVR应谨慎评估。
