Higher mycophenolate dosage is associated with an increased risk of squamous cell carcinoma in kidney transplant recipients.

Autor: Shao EX; Cancer and Population Studies, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia; Faculty of Medicine, The University of Queensland, St Lucia, QLD 4072, Australia. Electronic address: emilyxshao@gmail.com., Betz-Stablein B; Cancer and Population Studies, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia., Marquat L; Cancer and Population Studies, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia., Campbell S; Faculty of Medicine, The University of Queensland, St Lucia, QLD 4072, Australia; Department of Renal Medicine, Princess Alexandra Hospital Metro South, 199 Ipswich Rd, Woolloongabba, ALD 4102, Australia., Isbel N; Faculty of Medicine, The University of Queensland, St Lucia, QLD 4072, Australia; Department of Renal Medicine, Princess Alexandra Hospital Metro South, 199 Ipswich Rd, Woolloongabba, ALD 4102, Australia., Green AC; Cancer and Population Studies, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia; CRUK Manchester Institute and Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom., Plasmeijer EI; Cancer and Population Studies, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia; Netherlands Cancer Institute, Department of Dermatology, Amsterdam, the Netherlands.
Jazyk: angličtina
Zdroj: Transplant immunology [Transpl Immunol] 2022 Dec; Vol. 75, pp. 101698. Date of Electronic Publication: 2022 Aug 19.
DOI: 10.1016/j.trim.2022.101698
Abstrakt: Background: Kidney transplant recipients are at increased risk of keratinocyte cancers, namely squamous cell and basal cell carcinomas (SCCs and BCCs). This is primarily due to the high levels of immunosuppression that are required to prevent allograft rejection. Different immunosuppressive medications confer different risks, and the effect of mycophenolate mofetil on SCC and BCC risk is unclear. We explored the relationship between mycophenolate dose prescribed over the entire transplant period and the risk of SCC and BCC.
Methods: Kidney transplant recipients from Queensland, Australia, were recruited between 2012 and 2014 and followed until mid-2016. During this time transplant recipients underwent regular skin examinations to diagnose incident SCCs and BCCs. Immunosuppressive medication regimens were obtained from hospital records, and the average mycophenolate dose/day over the entire transplantation period was calculated for each patient. Doses were divided into three ranked groups, and adjusted relative risks (RR adj ) of developing SCC and BCC tumours were calculated using negative binomial regression with the lowest dosage group as reference. Recipients who had used azathioprine previously were excluded; further sub-group analysis was performed for other immunosuppressant medications.
Results: There were 134 kidney transplant recipients included in the study. The average age was 55, 31% were female and 69% were male. At the highest median mycophenolate dose of 1818 mg/day the SCC risk doubled (RR adj 2.22, 95% CI 1.03-4.77) when compared to the reference group of 1038 mg/day. An increased risk persisted after accounting for ever-use of ciclosporin, ever-use of tacrolimus, and when excluding mammalian target of rapamycin users. This increased risk was mainly carried by kidney transplant recipients immunosuppressed for five or more years (RR adj  = 11.05 95% CI 2.50-48.81). In contrast, there was no significant association between BCC incidence and therapy with the highest compared with the lowest mycophenolate dosage (RR adj  = 1.27 95% CI 0.56-2.87).
Conclusion: Higher mycophenolate dosage is associated with increased SCCs in kidney transplant recipients, particularly those immunosuppressed for more than five years. The increased SCC risk persists after accounting for usage of other immunosuppressant medications.
Competing Interests: Declaration of Competing Interest No conflict of interests are declared.
(Copyright © 2022. Published by Elsevier B.V.)
Databáze: MEDLINE
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