Effect of mechanistic target of rapamycin inhibitors on postrenal transplantation malignancy: A nationwide cohort study

Abstract

BackgroundPost‐transplantation malignancy influenced graft survival and overall survival in the patients receiving renal transplantation. Immunosuppressants influenced the immune surveillance, but whether immunosuppressive agents have impact for incidence of post‐transplantation malignancy is still elusive in Taiwan.MethodWe conducted a nationwide population‐based study. Patients who did not have malignancy history and received kidney transplantation between 2000 and 2010 were enrolled. Specific immunosuppressive users are defined as sustained use (more than 12 months) after renal transplantation. The primary outcome is the development of cancer after kidney transplantation. A Cox proportional hazards model was used to determine the risk of cancer development.ResultAmong 4438 recipients, 559 of them were diagnosed with malignancy after 1 year of transplantation. A total of 742 of recipients were as user of mechanistic target of rapamycin (mTOR) inhibitors. The mTOR users had higher rate of receiving pulse therapy. The hazard ratios (HR) for mTOR inhibitor users with exposure more than 5 years for overall malignancy and urothelial malignancy were 0.68 (95% CI: 0.48‐0.95, P = 0.02) and 0.60 (95% CI: 0.36‐0.99, P = 0.02), respectively. For the overall mortality and reentry of dialysis, the probability of both groups was similar (overall mortality: P = 0.53; reentry of dialysis: P = 0.77).ConclusionAmong the recipients of renal transplantation in Taiwan, mTOR inhibitors with exposure more than 5 years provided a protective role in reducing the risk of overall neoplasm and urothelial malignancy. The probability of reentry of dialysis and overall mortality was similar between the mTORi users and nonusers.

The Efficacy of COVID-19 Vaccines in Chronic Kidney Disease and Kidney Transplantation Patients: A Narrative Review

“…The use of mTORis in solid organ transplantation patients is growing. The advantage the use of mTORis is the lower incidence of posttransplantation diabetes mellitus and malignancy and the lower nephrotoxicity than with the use of CNIs [ 89 , 90 ]. mTOR inhibitors downregulate the proliferation of T and B lymphocytes [ 83 , 87 ].…”

Alteraciones neoplásicas en el paciente trasplantado renal. Una revisión sistemática

“…De este modo, accediendo a la evidencia actual, se puede decir que el uso de mTORi muestra resultados favorables entre esta población. En primer lugar, este tipo de inmunosupresor ha mostrado un papel protector en lo que respecta a la disminución del riesgo, tanto de aparición como de recaída, de neoplasia maligna, así como también ha evidenciado la obtención de una baja tasa de rechazo al injerto y un mantenimiento de una función renal estable [42][43][44] . Sin embargo, este fármaco no está exento de riesgos, destacando entre estos la proteinuria, la dislipemia y la anemia, por lo que deberá utilizarse bajo unas indicaciones muy precisas y en unas condiciones determinadas 44 .…”