COMMENTARY

Controlling Skin Cancer in Renal Transplant Patients

Ron Shapiro, MD

Disclosures

July 21, 2010

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Hi. My name is Ron Shapiro. I'm a transplant surgeon at the University of Pittsburgh. Today I want to talk to you about the use of conversion to sirolimus-based immunosuppression in patients who develop excessive numbers of skin cancers after kidney transplantation.

Primarily this is thought to be a problem with azathioprine. Certainly skin cancers are well established as the most common cancer after kidney transplantation.

In patients who are out a long period of time, the number of these cancers can be pretty extensive, and the consequences can be more than trivial. A fair bit of anecdotal evidence has suggested that sirolimus can retard or slow down or even reverse the rate of progression of these skin cancers. This randomized trial from Germany[1] lends definitive proof that even at 6 months and certainly by 12 months, the rate of progression and the number of cancers were substantially reduced in a very nicely done study where the dermatologists were blinded as to the immunosuppression that the patients were receiving.

Of note, over a quarter of the patients (7 out of 25) who were randomly assigned to be converted to sirolimus wound up dropping out of the sirolimus group because of side effects. So sirolimus isn't necessarily a perfect answer, but it provides really dramatic evidence that conversion to sirolimus can be effective in reducing the rate of skin cancers in patients who have undergone kidney transplantation.

Thank you.

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