De novo or early conversion to everolimus and long-term cancer outcomes in kidney transplant recipients: A trial-based linkage study

Tracey Ying, Germaine Wong, Wai Lim, John Kanellis, Helen Pilmore, Scott Campbell, Rosemary Masterson, Rowan Walker, Philip O'Connell, Graeme Russ, Steven Chadban

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Choice of immunosuppression may modify the risk of cancer after kidney transplantation, however, long-term data are lacking. Using the Australian and New Zealand Dialysis and Transplant Registry, we compared the 9-year risk of incident cancer, non-melanoma skin cancer (NMSC), and death attributed to cancer among participants from Australia and New Zealand in four randomized-controlled trials which compared de novo or early switch to an everolimus-containing regimen with calcineurin-inhibitor-based triple therapy. An adjusted Cox-model with random effects was used to determine such risks. Two hundred seventy-nine patients (192 everolimus, 87 control) were followed for a median of 9 years (IQR 6.7, 11.2). Compared with control, everolimus use was not associated with a reduction in the risk of incident cancer, NMSC, or cancer-related death (unadjusted HR [95% CI] 0.86 [0.49-1.48], 0.58 [0.30-1.12], and 1.18 [0.32-4.38], respectively). Subgroup analyses showed a 56% reduction for NMSC in patients randomized to everolimus + reduced-dose calcineurin-inhibitor versus control (unadjusted HR 0.44 [0.21-0.92]), which remained significant after adjusting for age, gender and smoking (adjusted HR 0.45 [0.21-0.96]). Although de novo or early switch to everolimus did not alter the 9-year risk of incident cancer or cancer-related death, everolimus with reduced-dose calcineurin-inhibitor strategy may reduce the long-term risk of NMSC.

Original languageEnglish
Pages (from-to)2977-2986
Number of pages10
JournalAmerican journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
Volume18
Issue number12
DOIs
Publication statusPublished - 1 Dec 2018

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Skin Neoplasms
Kidney
Neoplasms
New Zealand
Kidney Neoplasms
Risk Reduction Behavior
Proportional Hazards Models
Kidney Transplantation
Immunosuppression
Registries
Everolimus
Transplant Recipients
Dialysis
Randomized Controlled Trials
Smoking
Transplants
Calcineurin Inhibitors
Therapeutics

Cite this

Ying, Tracey ; Wong, Germaine ; Lim, Wai ; Kanellis, John ; Pilmore, Helen ; Campbell, Scott ; Masterson, Rosemary ; Walker, Rowan ; O'Connell, Philip ; Russ, Graeme ; Chadban, Steven. / De novo or early conversion to everolimus and long-term cancer outcomes in kidney transplant recipients : A trial-based linkage study. In: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2018 ; Vol. 18, No. 12. pp. 2977-2986.
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abstract = "Choice of immunosuppression may modify the risk of cancer after kidney transplantation, however, long-term data are lacking. Using the Australian and New Zealand Dialysis and Transplant Registry, we compared the 9-year risk of incident cancer, non-melanoma skin cancer (NMSC), and death attributed to cancer among participants from Australia and New Zealand in four randomized-controlled trials which compared de novo or early switch to an everolimus-containing regimen with calcineurin-inhibitor-based triple therapy. An adjusted Cox-model with random effects was used to determine such risks. Two hundred seventy-nine patients (192 everolimus, 87 control) were followed for a median of 9 years (IQR 6.7, 11.2). Compared with control, everolimus use was not associated with a reduction in the risk of incident cancer, NMSC, or cancer-related death (unadjusted HR [95{\%} CI] 0.86 [0.49-1.48], 0.58 [0.30-1.12], and 1.18 [0.32-4.38], respectively). Subgroup analyses showed a 56{\%} reduction for NMSC in patients randomized to everolimus + reduced-dose calcineurin-inhibitor versus control (unadjusted HR 0.44 [0.21-0.92]), which remained significant after adjusting for age, gender and smoking (adjusted HR 0.45 [0.21-0.96]). Although de novo or early switch to everolimus did not alter the 9-year risk of incident cancer or cancer-related death, everolimus with reduced-dose calcineurin-inhibitor strategy may reduce the long-term risk of NMSC.",
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De novo or early conversion to everolimus and long-term cancer outcomes in kidney transplant recipients : A trial-based linkage study. / Ying, Tracey; Wong, Germaine; Lim, Wai; Kanellis, John; Pilmore, Helen; Campbell, Scott; Masterson, Rosemary; Walker, Rowan; O'Connell, Philip; Russ, Graeme; Chadban, Steven.

In: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, Vol. 18, No. 12, 01.12.2018, p. 2977-2986.

Research output: Contribution to journalArticle

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T1 - De novo or early conversion to everolimus and long-term cancer outcomes in kidney transplant recipients

T2 - A trial-based linkage study

AU - Ying, Tracey

AU - Wong, Germaine

AU - Lim, Wai

AU - Kanellis, John

AU - Pilmore, Helen

AU - Campbell, Scott

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AU - Russ, Graeme

AU - Chadban, Steven

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