Conversion to sirolimus in kidney transplant recipients with squamous cell cancer and changes in immune phenotype.
Carroll RP, Hester J, et al.Nephrology Dialysis Transplantation. 2013; 28 (2): 462-465.
Aims
To investigate whether conversion to mTOR inhibitors leads to significant changes in immune phenotype of peripherally circulating lymphocytes.
Interventions
Continuation of current therapy or switch to 5 mg of prednisolone and sirolimus (trough levels 5–10 ng/mL). Every 3 months until 2 years of follow-up, patients were assessed by a dermatologist and any suspicious lesions biopsied and/or resected. At baseline, 3, 6 and 24 months, patients were also immune phenotyped with the laboratory technician blinded to the randomization status.
Participants
32 patients from the RESCUE study with a functioning transplant and at least one histologically diagnosed cell carcinoma of the skin (SCC).
Outcomes
Changes in immune phenotype, number of SCCs.
Follow-up
2 years
CET Conclusions
In this small pilot study an immune phenotype was assessed in patients following conversion to sirolimus from a CNI. Their results suggested that the conversion may unmask CNI inhibition of Foxp3 expression and this in turn might allow prediction of those transplant recipients who will continue to develop SCCs despite conversion to sirolimus. These are interesting findings and do need a much larger evaluation, particularly bearing in mind the importance of skin cancers in the transplant recipient.
Data analysis
Available case analysis
Trial registration
Not reported