title: Reductions in immunosuppression after haematological or solid organ cancer diagnosis in kidney transplant recipients.
abstract: Few data exist on how immunosuppression is altered in kidney transplant recipients (KTR) following a diagnosis of cancer. This study investigated how immunosuppression was altered in KTR after cancer diagnosis and its effect on patient and graft survival. All KTR diagnosed with cancer at our centre from 1990 to 2012 were assessed. Drug regime and serum creatinine levels were recorded 1 year before, at time of, and 1 year after cancer diagnosis. Of 87 KTR who developed cancer (7.3% of transplanted population, n = 1189), 30 developed haematological malignancies and 57 developed solid organ cancers (SOC). In total, 38% of KTR presented with nodal or metastatic disease and 23 of 87 (26%) KTR died within 6 months of cancer diagnosis. Fifty-five KTR had records of pre- and postcancer diagnosis drug regimes. Thirty-six KTR had a (>50%) dose reduction or cessation of 1 or more immunosuppressive agents, and 19 no reduction in immunosuppression. In total, 2 of 36 (6%) of KTR who underwent a dose reduction suffered acute rejection that was reversed with methylprednisolone. Dose reduction/cessation of immunosuppression did not impair graft function, but also did not affect cancer free survival. Further larger prospective studies are needed to determine whether dose reduction alters relapse free cancer survival in KTR.
authors.affiliation: Central Northern Adelaide Renal and Transplantation Service (CNARTS), Adelaide, SA, Australia.|Centre for Clinical and Experimental Transplantation (CCET), Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Hope
authors.affiliation: Central Northern Adelaide Renal and Transplantation Service (CNARTS), Adelaide, SA, Australia.
authors.forename: Alice J
authors.initials: AJ
authors.lastname: Krige
authors.affiliation: Central Northern Adelaide Renal and Transplantation Service (CNARTS), Adelaide, SA, Australia.
authors.forename: Alex
authors.initials: A
authors.lastname: Barratt
authors.affiliation: Central Northern Adelaide Renal and Transplantation Service (CNARTS), Adelaide, SA, Australia.|Centre for Clinical and Experimental Transplantation (CCET), Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Carroll
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D009369:Neoplasms / Q000150:complications*; D009520:New Zealand; D012008:Recurrence; D051437:Renal Insufficiency / Q000150:complications* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine; D008775:Methylprednisolone
keywords: immunosuppression; immunosuppression tapering; kidney transplantation; malignancy; registry