Conversion to mammalian target of rapamycin inhibitors in kidney transplant recipients with de novo cancers.
OBJECTIVE
To investigate the impact of mammalian target of rapamycin (mTOR) inhibitor conversion together with minimization of calcineurin inhibitor on allograft outcome and patient survival in kidney transplant recipients with post-transplant cancers.


METHODS
A retrospective study of all kidney transplant recipients diagnosed to have post-transplant cancers between the period 1/1/1994 and 30/6/2015. Patients were divided into 2 groups: mTOR inhibitor group and non-conversion group. Outcome included allograft function, patient survival, graft survival, acute rejection and cancer recurrence.


RESULTS
115 patients (56 in mTOR inhibitor group and 59 in non-conversion group) were analyzed. Median follow up was 28 months (range: 1 month - 20 years). The allograft function at 1-year remained similar between both groups. There was no significant difference in the patient survival, graft survival and rejection free survival between both groups. More patients in the non-conversion group developed recurrence of cancers than mTOR inhibitor group but statistically not significant.


CONCLUSIONS
Use of mTOR inhibitors together with calcineurin inhibitor minimization offer a reasonable option in kidney transplant recipients who developed post-transplant cancers in view of stable renal function, low rejection rate and low cancer recurrence rate.
Department of Medicine, Renal Unit, Queen Elizabeth Hospital, Hong Kong SAR.
Chi Yuen
CY
Cheung
Department of Medicine, Division of Nephrology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR.
Maggie Kam
MK
Man Ma
Department of Medicine, Renal Unit, Queen Elizabeth Hospital, Hong Kong SAR.
Wai Leung
WL
Chak
Department of Medicine, Renal Unit, Queen Elizabeth Hospital, Hong Kong SAR.
Ka Foon
KF
Chau
Department of Medicine, Division of Nephrology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR.
Sydney Chi Wai
SCW
Tang
D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*; D014184:Transplantation, Homologous
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D047428:Protein Kinase Inhibitors; D058570:TOR Serine-Threonine Kinases
cancer; everolimus; kidney transplant; sirolimus