The British journal of dermatology · 2026
Immunosuppressive regimens and skin cancer risk in solid-organ transplant recipients.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Gómez-Tomás Álvaro, González-Cruz Carlos, García-Patos Vicente, Ferrándiz-Pulido Carla
Аннотация
BACKGROUND: Solid organ transplant recipients (SOTRs) are at increased risk of developing skin cancer due to long-term immunosuppressive (IS) therapy. Calcineurin inhibitors (CNIs), particularly tacrolimus and ciclosporin, are associated with elevated skin cancer risk. Mammalian -target of rapamycin inhibitors (mTORis) are considered protective, but real-life evidence of their effectiveness, especially when combined with reduced-dose CNIs, is limited. Understanding the impact of current IS regimens on skin cancer risk is essential for improving patient outcomes.
OBJECTIVES: To evaluate the relative risk of different IS drugs and regimens on skin cancer development in SOTRs.
METHODS: We conducted a prospective observational study at Vall d'Hebron University Hospital, Barcelona, Spain, from 2011 to 2021. The study included 1055 SOTRs from a mixed-organ cohort, with a combined follow-up of 3336 person-years. Real-life IS drug regimens were recorded during scheduled posttransplant screenings or dermatological follow-ups. Cox proportional hazards models with shared frailty were used to assess skin cancer risk, accounting for multiple events and adjusting for time-varying drug exposure.
RESULTS: Skin cancer occurred in 131 of 1055 SOTRs (12.4%). A total of 450 skin cancer events were registered, including 317 squamous cell carcinomas (70%), 118 basal cell carcinomas (26%) and 15 melanomas (3%). mTORi-based regimens were associated with significantly lower skin cancer rates [hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.47-0.92; P = 0.01]. Everolimus appeared more protective than sirolimus (HR 0.38, 95% CI 0.21-0.69; P < 0.001). Reduced-dose CNIs combined with mTORis were linked to a 37% reduction in skin cancer rates in high-risk patients (HR 0.63, 95% CI 0.42-0.93; P = 0.02) and a 32% reduction in patients with posttransplant events (HR 0.68, 95% CI 0.47-0.98; P = 0.04). The reduction was mainly driven by decreased squamous cell carcinoma incidence.
CONCLUSIONS: mTORi-based regimens, particularly with reduced-dose tacrolimus, appear to offer a safer and more effective alternative to CNI-heavy regimens for skin cancer prevention in SOTRs. Real-life data support the integration of mTORis into IS strategies to reduce skin cancer risk, particularly for high-risk patients and those who developed skin malignancies. An author video to accompany this article is available online.
OBJECTIVES: To evaluate the relative risk of different IS drugs and regimens on skin cancer development in SOTRs.
METHODS: We conducted a prospective observational study at Vall d'Hebron University Hospital, Barcelona, Spain, from 2011 to 2021. The study included 1055 SOTRs from a mixed-organ cohort, with a combined follow-up of 3336 person-years. Real-life IS drug regimens were recorded during scheduled posttransplant screenings or dermatological follow-ups. Cox proportional hazards models with shared frailty were used to assess skin cancer risk, accounting for multiple events and adjusting for time-varying drug exposure.
RESULTS: Skin cancer occurred in 131 of 1055 SOTRs (12.4%). A total of 450 skin cancer events were registered, including 317 squamous cell carcinomas (70%), 118 basal cell carcinomas (26%) and 15 melanomas (3%). mTORi-based regimens were associated with significantly lower skin cancer rates [hazard ratio (HR) 0.66, 95% confidence interval (CI) 0.47-0.92; P = 0.01]. Everolimus appeared more protective than sirolimus (HR 0.38, 95% CI 0.21-0.69; P < 0.001). Reduced-dose CNIs combined with mTORis were linked to a 37% reduction in skin cancer rates in high-risk patients (HR 0.63, 95% CI 0.42-0.93; P = 0.02) and a 32% reduction in patients with posttransplant events (HR 0.68, 95% CI 0.47-0.98; P = 0.04). The reduction was mainly driven by decreased squamous cell carcinoma incidence.
CONCLUSIONS: mTORi-based regimens, particularly with reduced-dose tacrolimus, appear to offer a safer and more effective alternative to CNI-heavy regimens for skin cancer prevention in SOTRs. Real-life data support the integration of mTORis into IS strategies to reduce skin cancer risk, particularly for high-risk patients and those who developed skin malignancies. An author video to accompany this article is available online.