title: Maintenance versus reduction of immunosuppression in renal transplant recipients with aggressive squamous cell carcinoma.
abstract: BACKGROUND
  There has been a significant increase in skin cancers in transplant patients in recent years. Transplant recipients are also more likely to develop skin cancers that are locally invasive with the potential to metastasize early.
  
  
  OBJECTIVE
  This study aimed to determine the effect of significantly reducing or stopping immunosuppressive therapy on prognosis of aggressive squamous cell carcinomas (SCC) in renal transplant recipients (RTRs).
  
  
  METHODS
  Retrospective study of nine patients with aggressive SCC identified two groups, one whose immunosuppressive therapy was not altered and the other who had their therapy stopped or significantly reduced.
  
  
  RESULTS
  Aggressive SCC all occurred on the head and neck, with five of the primary tumors originating from the ear. Using a Wilcoxon-Breslow test to compare equality of survivor functions, reducing or stopping immunosuppression was associated with the prolongation of metastatic disease-free survival period (p=0.023).
  
  
  CONCLUSIONS
  This nonrandomized pilot study suggests that reduction of immunosuppression in RTRs with aggressive SCC may improve prognosis compared to patients whose immunosuppression is unchanged. Allograft function may continue despite significant reduction of immunosuppression.
authors.affiliation: Department of Dermatology, Beaumont Hospital, Dublin, Ireland.
authors.forename: F J
authors.initials: FJ
authors.lastname: Moloney
authors.forename: P O
authors.initials: PO
authors.lastname: Kelly
authors.forename: E W
authors.initials: EW
authors.lastname: Kay
authors.forename: P
authors.initials: P
authors.lastname: Conlon
authors.forename: G M
authors.initials: GM
authors.lastname: Murphy
mesh_terms: D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000209:etiology / Q000276:immunology / Q000473:pathology*; D004305:Dose-Response Relationship, Drug; D006258:Head and Neck Neoplasms / Q000209:etiology / Q000276:immunology / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000276:immunology*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis; D010865:Pilot Projects; D011379:Prognosis; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000209:etiology / Q000276:immunology / Q000473:pathology*
chemical_list: D007166:Immunosuppressive Agents