AUTHOR=Re Sartò Giulia Vanessa , Alfieri Carlo , Cosmai Laura , Brigati Emilietta , Campise Mariarosaria , Regalia Anna , Verdesca Simona , Molinari Paolo , Pisacreta Anna Maria , Pirovano Marta , Nardelli Luca , Gallieni Maurizio , Castellano Giuseppe 

TITLE=Post-Kidney Transplant Cancer: A Real-World Retrospective Analysis From a Single Italian Center

JOURNAL=Transplant International

VOLUME=Volume 37 - 2024

YEAR=2024

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2024.13220

DOI=10.3389/ti.2024.13220

ISSN=1432-2277

ABSTRACT=We describe the epidemiology of cancer after kidney-transplant(KTx), investigating its risk factors and impact on therapeutic management and survival in KTx-recipients (KTRs). The association between modification of immunosuppressive(IS) therapy after cancer and survival outcomes was analyzed. We collected data of 930-KTRs followed-up for 7[1-19]years. The majority of KTRs received KTx from a deceased donor (84%). 74% underwent induction therapy with basiliximab and 26% with ATG.Maintenance therapy included steroids, calcineurin-inhibitors, and mycophenolate. Patients with at least one cancer (CA+) were 19%. NMSC were the most common tumors(55%). CA+ were older and had a higher BMI. Vasculitis and ADPKD were more prevalent in CA+. ATG was independently associated to CA+ and, in survival and competing risk analyses, was related to the earlier cancer development (p=0.01 and <0.0001;basiliximab 89±4 vs ATG 40±4 months). After cancer diagnosis, significant prognostic impact was derived from the shift to mTOR-inhibitors compared with one definitive IS-drug suspension(p=0.004). Our data confirm the relevance of cancer as complication in KTRs with ATG representing an independent risk factor. A personalized choice of IS to be proposed at the KTx is crucial in the prevention of neoplastic risk. Finally, the shift to mTORi might represent an important strategy to improve patient survival.