MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Patients who receive a kidney transplant as treatment for end stage kidney disease are at risk of malignancy due to immunosuppression. In contrast to
other solid organ transplant types, when kidney transplants fail it is possible for recipients to return to dialysis. Immunosuppression is usually reduced or completely stopped when the allograft fails due to the risk of infection on dialysis.
We decided to investigate what the trajectory of risk for non-melanoma skin cancer and invasive cancers overall (composite group) looked like for patients who have received multiple consecutive kidney transplants with intervening periods of graft failure. We compared cancer risk during periods of allograft failure and periods of functioning kidney transplants.
MedicalResearch.com: What should readers take away from your report?
Response: While the risk of skin cancer is higher during periods of functioning transplant than during periods of graft failure, the risk of skin cancer and cancer overall is still higher than the general population during these periods of graft failure.
While it is possible that medical surveillance post transplant contributed to ascertainment bias for non melanoma skin cancer, the trends in overall invasive cancer suggest that physicians looking after patients with failed transplants should be cognizant of the residual elevated risk of malignancy. This may be related to possible lag effects of immunosuppression on cancer development.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Studies aimed at optimizing and individualizing immunosuppressive regimes are needed.
Sexton DJ, O’Kelly P, O’Leary E, et al. Variation in Nonmelanoma Skin Cancer Incidence by Treatment Modality Among Patients Receiving Multiple Kidney Transplants. JAMA Dermatol. Published online February 06, 2019. doi:10.1001/jamadermatol.2018.4660
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