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    Higher mycophenolate dosage is associated with an increased risk of squamous cell carcinoma in kidney transplant recipients

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    Authors
    Shao, E. X.
    Betz-Stablein, B.
    Marquat, L.
    Campbell, S.
    Isbel, N.
    Green, Adèle C
    Plasmeijer, E. I.
    Affiliation
    Cancer and Population Studies, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australiads.
    Issue Date
    2022
    
    Metadata
    Show full item record
    Abstract
    Background: Kidney transplant recipients are at increased risk of keratinocyte cancers, namely squamous cell and basal cell carcinomas (SCCs and BCCs). This is primarily due to the high levels of immunosuppression that are required to prevent allograft rejection. Different immunosuppressive medications confer different risks, and the effect of mycophenolate mofetil on SCC and BCC risk is unclear. We explored the relationship between mycophenolate dose prescribed over the entire transplant period and the risk of SCC and BCC. Methods: Kidney transplant recipients from Queensland, Australia, were recruited between 2012 and 2014 and followed until mid-2016. During this time transplant recipients underwent regular skin examinations to diagnose incident SCCs and BCCs. Immunosuppressive medication regimens were obtained from hospital records, and the average mycophenolate dose/day over the entire transplantation period was calculated for each patient. Doses were divided into three ranked groups, and adjusted relative risks (RRadj) of developing SCC and BCC tumours were calculated using negative binomial regression with the lowest dosage group as reference. Recipients who had used azathioprine previously were excluded; further sub-group analysis was performed for other immunosuppressant medications. Results: There were 134 kidney transplant recipients included in the study. The average age was 55, 31% were female and 69% were male. At the highest median mycophenolate dose of 1818 mg/day the SCC risk doubled (RRadj 2.22, 95% CI 1.03-4.77) when compared to the reference group of 1038 mg/day. An increased risk persisted after accounting for ever-use of ciclosporin, ever-use of tacrolimus, and when excluding mammalian target of rapamycin users. This increased risk was mainly carried by kidney transplant recipients immunosuppressed for five or more years (RRadj = 11.05 95% CI 2.50-48.81). In contrast, there was no significant association between BCC incidence and therapy with the highest compared with the lowest mycophenolate dosage (RRadj = 1.27 95% CI 0.56-2.87). Conclusion: Higher mycophenolate dosage is associated with increased SCCs in kidney transplant recipients, particularly those immunosuppressed for more than five years. The increased SCC risk persists after accounting for usage of other immunosuppressant medications.
    Citation
    Shao EX, Betz-Stablein B, Marquat L, Campbell S, Isbel N, Green AC, et al. Higher mycophenolate dosage is associated with an increased risk of squamous cell carcinoma in kidney transplant recipients. Transplant immunology. 2022 Aug 18:101698. PubMed PMID: 35988897. Epub 2022/08/22. eng.
    Journal
    Transplant Immunology
    URI
    http://hdl.handle.net/10541/625581
    DOI
    10.1016/j.trim.2022.101698
    PubMed ID
    35988897
    Additional Links
    https://dx.doi.org/10.1016/j.trim.2022.101698
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.trim.2022.101698
    Scopus Count
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