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Review article
peer-reviewed

The Effect of Conversion from a Calcineurin Inhibitor to Sirolimus on Skin Cancer Reduction in Post-renal Transplantation Patients



Abstract

In kidney transplant patients, skin cancer is the most commonly involved neoplasm. More than 90% of post-transplantation skin cancers are nonmelanoma skin cancers (NMSCs). The majority of them are squamous cell carcinomas and basal cell carcinomas. Calcineurin inhibitors (CNIs) such as cyclosporine and tacrolimus are immunosuppressive agents given after solid organ transplantation, but they can also promote tumor growth. Sirolimus is a novel class of immunosuppressants and has been proven to have antineoplastic properties. We review clinical trials and meta-analyses studying if conversion from CNI to sirolimus in post-renal transplantation patients decreases the development of NMSCs. A critical appraisal of the literature demonstrated that, while smaller scale studies tended to yield no clinically significant data, larger clinical trials and meta-analyses supported the conclusion that converting to sirolimus in post-renal transplant patients leads to reductions in skin cancer development. As a result, we conclude that conversion to sirolimus likely reduces NMSC in post-renal transplantation patients. Larger scale clinical trials with more rigorous stratification and less patient dropout rate are needed for more definitive conclusions.



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Review article
peer-reviewed

The Effect of Conversion from a Calcineurin Inhibitor to Sirolimus on Skin Cancer Reduction in Post-renal Transplantation Patients


Author Information

Aaron Smith Corresponding Author

College of Medicine, University of Central Florida

Wei Niu

College of Medicine, University of Central Florida

Anand Desai

College of Medicine, University of Central Florida


Ethics Statement and Conflict of Interest Disclosures

Conflicts of interest: The authors have declared that no conflicts of interest exist.


Review article
peer-reviewed

The Effect of Conversion from a Calcineurin Inhibitor to Sirolimus on Skin Cancer Reduction in Post-renal Transplantation Patients


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Review article
peer-reviewed

The Effect of Conversion from a Calcineurin Inhibitor to Sirolimus on Skin Cancer Reduction in Post-renal Transplantation Patients

  • Author Information
    Aaron Smith Corresponding Author

    College of Medicine, University of Central Florida

    Wei Niu

    College of Medicine, University of Central Florida

    Anand Desai

    College of Medicine, University of Central Florida


    Ethics Statement and Conflict of Interest Disclosures

    Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: August 13, 2017

    DOI

    10.7759/cureus.1564

    Cite this article as:

    Smith A, Niu W, Desai A (August 13, 2017) The Effect of Conversion from a Calcineurin Inhibitor to Sirolimus on Skin Cancer Reduction in Post-renal Transplantation Patients. Cureus 9(8): e1564. doi:10.7759/cureus.1564

    Publication history

    Received by Cureus: May 17, 2017
    Peer review began: July 26, 2017
    Peer review concluded: July 29, 2017
    Published: August 13, 2017

    Copyright

    © Copyright 2017
    Smith et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

In kidney transplant patients, skin cancer is the most commonly involved neoplasm. More than 90% of post-transplantation skin cancers are nonmelanoma skin cancers (NMSCs). The majority of them are squamous cell carcinomas and basal cell carcinomas. Calcineurin inhibitors (CNIs) such as cyclosporine and tacrolimus are immunosuppressive agents given after solid organ transplantation, but they can also promote tumor growth. Sirolimus is a novel class of immunosuppressants and has been proven to have antineoplastic properties. We review clinical trials and meta-analyses studying if conversion from CNI to sirolimus in post-renal transplantation patients decreases the development of NMSCs. A critical appraisal of the literature demonstrated that, while smaller scale studies tended to yield no clinically significant data, larger clinical trials and meta-analyses supported the conclusion that converting to sirolimus in post-renal transplant patients leads to reductions in skin cancer development. As a result, we conclude that conversion to sirolimus likely reduces NMSC in post-renal transplantation patients. Larger scale clinical trials with more rigorous stratification and less patient dropout rate are needed for more definitive conclusions.



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Aaron Smith, Medical Student

College of Medicine, University of Central Florida

For correspondence:
aaron_smith@knights.ucf.edu

Wei Niu

College of Medicine, University of Central Florida

Anand Desai

College of Medicine, University of Central Florida

Aaron Smith, Medical Student

College of Medicine, University of Central Florida

For correspondence:
aaron_smith@knights.ucf.edu

Wei Niu

College of Medicine, University of Central Florida

Anand Desai

College of Medicine, University of Central Florida