title: Nonmelanoma Skin Cancers After Kidney Transplant: Our 15 Years of Experience With Mammalian Target of Rapamycin Inhibitors.
abstract: We evaluated patients with nonmelanoma skin cancer after kidney transplant and the effects of immunosuppression reduction and switching to a mammalian target of rapamycin inhibitor drugs.
  
  
  
  Kidney transplant recipients were evaluated retrospectively from patient medical records (between January 2000 and December 2014). A 30% increase in serum creatinine was accepted as indicating renal failure progression.
  
  
  
  Of 18 patients included (mean follow-up 98 ± 66 mo), 7 (38.8%) had squamous cell carcinoma, 7 (38.8%) had Kaposi sarcoma, and 4 (22.2%) had basal cell carcinoma. At cancer diagnosis, average serum creatinine was 1.6 ± 0.7 mg/dL and proteinuria was 410 ± 766 mg/d. Immunosuppression regimen was changed in 15 patients (83.3%), with new regimen being a single-drug (only prednisolone) in 4 patients, double-drug in 6 patients, and triple-drug protocol in 8 patients. Eight patients were switched to a mammalian target of rapamycin inhibitor-based double (4 patients) or triple (4 patients) regimen. During follow-up after starting new treatment (average 46 ± 50 mo), 6 patients (33.3%) had progressive kidney failure (0 were receiving triple regimen). Those that progressed were using mammalian target of rapamycin inhibitor-based drugs relatively less (33% vs 50%), although often receiving a single-drug immunosuppression treatment (50% vs 8.3%). Three patients (33.3%) had acute rejection (2 receiving double and 1 receiving single immunosuppression treatment). Five patients (27.7%) had local recurrence of the primary tumor. Mammalian target of rapamycin inhibitor use was relatively less common in patients with tumor relapse (20% vs 46%). One patient died (heart failure), and 1 with chronic rejection returned to dialysis.
  
  
  
  Mammalian target of rapamycin inhibitorbased drugs could reduce local recurrence rate in kidney transplant recipients with nonmelanoma skin cancers. Aggressive reduction and/or cessation of immunosuppressive drugs after skin cancer can lead to graft rejection.
authors.affiliation: Department of General Surgery, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey.
authors.forename: Gokalp
authors.initials: G
authors.lastname: Okut
authors.forename: Alper
authors.initials: A
authors.lastname: Alp
authors.forename: Erhan
authors.initials: E
authors.lastname: Tatar
authors.forename: Cenk
authors.initials: C
authors.lastname: Simsek
authors.forename: Cem
authors.initials: C
authors.lastname: Tugmen
authors.forename: Adam
authors.initials: A
authors.lastname: Uslu
mesh_terms: D002280:Basal Cell Carcinoma / Q000139:chemically induced* / Q000191:economics / Q000276:immunology / Q000517:prevention & control; D002294:Carcinoma, Squamous Cell / Q000139:chemically induced* / Q000191:economics / Q000276:immunology / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D057915:Drug Substitution; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000191:economics; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000191:economics; D008499:Medical Records; D009364:Neoplasm Recurrence, Local; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012514:Sarcoma, Kaposi / Q000139:chemically induced* / Q000191:economics / Q000276:immunology / Q000517:prevention & control; D012878:Skin Neoplasms / Q000139:chemically induced* / Q000191:economics / Q000276:immunology / Q000517:prevention & control; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D047428:Protein Kinase Inhibitors; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases