title: Conversion to rapamycin immunosuppression for malignancy after kidney transplantation: case reports.
abstract: BACKGROUND
  Malignancies are a well-known complication of immunosuppressive therapy among renal transplant recipients, representing an important cause of long-term morbidity and mortality. Rapamycin has been shown to limit the proliferation of a number of malignant cell lines in vivo and in vitro.
  
  
  METHODS
  Eight patients developed the following malignancies after kidney transplantation (mean 102.6 months; range 12 to 252): metastatic gastric cancer (n = 1), metastatic colon cancer (n = 1), bilateral nephrourothelioma (n = 1), skin cancer (n = 1), Kaposi's sarcoma (n = 2), posttransplant lymphoproliferative disorder (PTLD) (n = 2). After the diagnosis of malignancy, the patients were switched from calcineurin inhibitor-based immunosuppression to rapamycin (monotherapy, n = 2), associated with steroids (n = 4) or mycophenolate mofetil (n = 2).
  
  
  RESULTS
  Both patients with metastatic cancer underwent chemotherapy and then succummbed after 6 and 13 months. After a mean follow-up of 20.3 months (range 2 to 47), the remaining six patients are free from cancer disease. Renal graft function was unchanged from diagnosis throughout the follow-up.
  
  
  CONCLUSIONS
  Our observations suggested that rapamycin-based immunosuppression offered the possibility of regression of nonmetastatic tumors. Nevertheless, it is difficult to assess whether tumor regression was attributed to Rapamycin treatment or to the reduced immunosuppression.
authors: Clinica Chirurgica AS Trapianti, Università Tor Vergata Ospedale S Eugenio, Roma, Italy.
authors: G
authors: G
authors: Iaria
authors: A
authors: A
authors: Anselmo
authors: L
authors: L
authors: De Luca
authors: M
authors: M
authors: Manuelli
authors: C
authors: C
authors: Lucchesi
authors: L
authors: L
authors: Tariciotti
authors: A
authors: A
authors: Monaco
authors: D
authors: D
authors: Sforza
authors: F
authors: F
authors: Nigro
authors: E
authors: E
authors: Abruzzese
authors: G
authors: G
authors: Tisone
mesh_terms: D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects*; D009369:Neoplasms / Q000175:diagnosis* / Q000276:immunology / Q000517:prevention & control; D011183:Postoperative Complications / Q000175:diagnosis*; D020123:Sirolimus / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus