Conversion to rapamycin immunosuppression for malignancy after kidney transplantation: case reports.
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.
Iaria
G
G
Clinica Chirurgica AS Trapianti, Università Tor Vergata Ospedale S Eugenio, Roma, Italy.
Anselmo
A
A
De Luca
L
L
Manuelli
M
M
Lucchesi
C
C
Tariciotti
L
L
Monaco
A
A
Sforza
D
D
Nigro
F
F
Abruzzese
E
E
Tisone
G
G
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*
D007166:Immunosuppressive Agents; D020123:Sirolimus