Systematic Review of Calcineurin Inhibitors and Incidence of Skin Malignancies after Kidney Transplantation in Adult Patients: A Study of 309,551 Cases

Author:

Kulbat Aleksandra123ORCID,Richter Karolina4,Stefura Tomasz23ORCID,Kołodziej-Rzepa Marta24,Kisielewski Michał24,Wojewoda Tomasz24,Wysocki Wojciech M.124ORCID

Affiliation:

1. The Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland

2. Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital in Kraków, 30-901 Kraków, Poland

3. Department of Medical Education, Jagiellonian University Medical College, 30-688 Kraków, Poland

4. Chair of Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland

Abstract

The purpose of this systematic review and meta-analysis was to compare the risk of non-melanoma skin cancer (NMSC) and melanoma development in renal transplant recipients who receive calcineurin inhibitors to that of patients treated with other immunosuppressive agents, and investigate the possible association between the type of maintenance immunosuppression and the incidence of NSMC and melanoma in this group of patients. The authors searched databases such as PubMed, Scopus, and Web of Science for articles that would help establish the influence of calcineurin inhibitors on skin cancer development. The inclusion criteria for the study consisted of randomized clinical trials, cohort studies, and case-control studies that compared patients who received kidney transplants and were treated with a calcineurin inhibitor (CNI), such as cyclosporine A (CsA) or tacrolimus (Tac), to those who received alternative immunosuppressants and did not receive a CNI. Seven articles were analyzed overall. The results revealed a correlation between CNI treatment in renal transplant recipients and increased total skin cancer risk (OR 1.28; 95% CI: 0.10–16.28; p < 0.01), melanoma risk (OR 1.09; 95% CI: 0.25–4.74; p < 0.01), and NMSC risk (OR 1.16; 95% CI: 0.41–3.26; p < 0.01). In conclusion, the calcineurin inhibitors used after kidney transplantation are associated with a higher risk of skin cancer—both non-melanoma and melanoma—when compared with other immunosuppressive therapies. This finding suggests that careful monitoring for skin lesions in post-transplant patients must be conducted. However, the decision on the kind of immunotherapy used should always be considered on an individual basis for each renal transplant recipient.

Publisher

MDPI AG

Reference42 articles.

1. Surgical complications after kidney transplantation;Haberal;Exp. Clin. Transpl.,2016

2. Cost comparison of kidney transplant versus dialysis in Brazil;Silva;Cad. Saude Publica,2016

3. The World Kidney Day Steering Committee 2012. The global role of kidney transplantation;Garcia;J. Nephropathol.,2012

4. Personalized immunosuppression after kidney transplantation;Cheung;Nephrology,2022

5. Immunosuppression en transplantation rénale [Immunosuppression in kidney transplantation];Legendre;Ann. Urol. (Paris),2007

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