title: Sirolimus and non-melanoma skin cancer prevention after kidney transplantation: a meta-analysis.
abstract: BACKGROUND
  Whether sirolimus is useful in the prevention of non-melanoma skin cancer (NMSC) remains unclear and we therefore performed this meta-analysis of randomized controlled trials to test the hypothesis that Sirolimus-based immunosuppression is associated with a decrease in NMSC.
  
  
  METHODS
  The main outcomes were NMSC, squamous-cell carcinoma and basal-cell carcinoma. The pooled risk ratio (RR) with its 95% confidence interval (95%CI) were used to assess the effects.
  
  
  RESULTS
  5 randomized trials involving a total of 1499 patients receiving kidney transplantation were included. Patients undergoing Sirolimus-based immunosuppression had much lower risk of NMSC (RR = 0.49, 95%CI 0.32-0.76, P = 0.001). Subgroup analyses by tumor type showed that Sirolimus-based immunosuppression significantly decreased risk of both squamous-cell carcinoma (RR = 0.58, 95%CI 0.43-0.78, P < 0.001) and basal-cell carcinoma (RR = 0.56, 95%CI 0.37-0.85, P = 0.006). The quality of evidence was high for NMSC, and moderate for squamous-cell carcinoma and basal-cell carcinoma. No evidence of publication bias was observed.
  
  
  CONCLUSIONS
  High quality evidence suggests that Sirolimus-based immunosuppression decreases risk of non-melanoma skin cancer, and Sirolimus has an antitumoral effect among kidney-transplant recipients.
authors.affiliation: Department of Pharmaceutics, the Third Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Yu-Hong
authors.initials: YH
authors.lastname: Gu
authors.forename: Jia-Xin
authors.initials: JX
authors.lastname: Du
authors.forename: Man-Ling
authors.initials: ML
authors.lastname: Ma
mesh_terms: D002280:Basal Cell Carcinoma / Q000209:etiology / Q000517:prevention & control*; D002294:Carcinoma, Squamous Cell / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects; D020123:Sirolimus / Q000627:therapeutic use*; D012878:Skin Neoplasms / Q000209:etiology / Q000517:prevention & control*
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus