Okut Gokalp, Alp Alper, Tatar Erhan, Simsek Cenk, Tugmen Cem, Uslu Adam
Department of General Surgery, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey.
Exp Clin Transplant. 2017 Feb;15(Suppl 1):236-239. doi: 10.6002/ect.mesot2016.p112.
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.
我们评估了肾移植后非黑色素瘤皮肤癌患者以及免疫抑制降低和改用雷帕霉素靶蛋白抑制剂药物的效果。
对肾移植受者进行回顾性评估（2000年1月至2014年12月）。血清肌酐升高30%被认为提示肾衰竭进展。
纳入的18例患者（平均随访98±66个月）中，7例（38.8%）患鳞状细胞癌，7例（38.8%）患卡波西肉瘤，4例（22.2%）患基底细胞癌。癌症诊断时，平均血清肌酐为1.6±0.7mg/dL，蛋白尿为410±766mg/d。15例患者（83.3%）改变了免疫抑制方案，新方案中4例患者为单药（仅泼尼松龙），6例患者为双药，8例患者为三药方案。8例患者改用基于雷帕霉素靶蛋白抑制剂的双药（4例）或三药（4例）方案。开始新治疗后的随访期间（平均46±50个月），6例患者（33.3%）出现进行性肾衰竭（0例接受三药方案）。进展患者使用基于雷帕霉素靶蛋白抑制剂的药物相对较少（33%对50%），尽管常接受单药免疫抑制治疗（50%对8.3%）。3例患者（33.3%）发生急性排斥反应（2例接受双药治疗，1例接受单药免疫抑制治疗）。5例患者（27.7%）出现原发肿瘤局部复发。在肿瘤复发患者中，雷帕霉素靶蛋白抑制剂的使用相对较少见（20%对46%）。1例患者死亡（心力衰竭），1例慢性排斥反应患者恢复透析。
基于雷帕霉素靶蛋白抑制剂的药物可降低肾移植非黑色素瘤皮肤癌患者的局部复发率。皮肤癌后积极降低和/或停用免疫抑制药物可导致移植排斥反应。
