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• W2005255277 abstract "P855 Aims: The development of malignancies after solid organ transplantation represents an increasing clinical problem complicating the long-term follow-up of transplant recipients. Treatment of these post-transplant tumors under chronic immunosuppression implies a substantial clinical challenge. Methods: This study analysed 35 cases of malignancy occurred after renal transplantation and examined the oncological management, immunosuppressive therapy, and long-term outcome. Results: Tumors occurred on average 35 months (2-62 months) after transplantation. The neoplasms were: skin cancers (12), lymphomas (3), urogenital carcinomas (6), tumors of the respiratory system (6), and cancers of other aetiology (8). Solid tumors received a radical tumor resection whenever possible. Adjuvant chemo-/radiotherapy was added according to the general recommendations for the respective tumor entities. Haematological neoplasms were treated with chemotherapy or local radiotherapy. R0 resection or total remission was achieved in 33 patients. Main immunosuppressive drugs (before tumor diagnosis) were MMF in 5 patients, tacrolimus (TAC)/MMF in 7, TAC 1, cyclosporine (CYA)/ MMF 4, CYA/azathioprine (AZA) 12 and CYA 6. After the development of a de novo tumor, 20 patients were converted to an other immunosuppressive regiment, 15 patients stayed on their primary immunosuppression. Patients were converted to sirolimus (SRL) (6), SRL/MMF (1), MMF (5), CYA/MMF (6), or to TAC/MMF (2). The most common conversion appeared to be switching from CYA or CYA/AZA based protocols to SRL (target trough level 4-7 ng/ml) or MMF. 6 patients with CYA/AZA, 1 patient with CYA/MMF and 1 with TAC/MMF showed reoccurrence of the primary tumor - 4 of these 8 patients were subsequently switched to SRL. In patients that had not been switched to other protocols, 4 patients died of cancer (2xTAC/MMF, MMF, CYA/AZA), while 3 deaths occurred in patients switched to other regimes (CYA/MMF, MMF, RAPA). Renal function was maintained in 34 patients with a mean serum creatinine value of 1,63±0,48 mg/dl in patients with a change in their treatment and 1,73±0,74 mg/dl in patients with no change in their immunosuppression. One graft was lost in a patient converted to SRL because of chronic allograft rejection. Conclusion: During tumor therapy good renal function was maintained in all but one patient. Patients seem to benefit from conversion to an antiproliferative protocol containing an mTOR inhibitor (SRL), showing an effective tumor control. However, when converting patients to SRL drug levels should carefully be monitored to avoid over-immunosuppression. Further studies are needed to justify a general recommendation for converting tumor patients to a mTOR-inhibitor based immunosuppressive protocol." @default.
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• W2005255277 date "2004-07-01" @default.
• W2005255277 modified "2023-10-18" @default.
• W2005255277 title "OUTCOME AND CLINICAL COURSE OF MALIGNANCIES IN RENAL TRANSPLANT RECIPIENTS" @default.
• W2005255277 doi "https://doi.org/10.1097/00007890-200407271-01351" @default.
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