PMID- 30117312 OWN - NLM STAT- MEDLINE DCOM- 20191114 LR - 20211204 IS - 2045-7634 (Electronic) IS - 2045-7634 (Linking) VI - 7 IP - 9 DP - 2018 Sep TI - Effect of mechanistic target of rapamycin inhibitors on postrenal transplantation malignancy: A nationwide cohort study. PG - 4296-4307 LID - 10.1002/cam4.1676 [doi] AB - BACKGROUND: Post-transplantation malignancy influenced graft survival and overall survival in the patients receiving renal transplantation. Immunosuppressants influenced the immune surveillance, but whether immunosuppressive agents have impact for incidence of post-transplantation malignancy is still elusive in Taiwan. METHOD: We conducted a nationwide population-based study. Patients who did not have malignancy history and received kidney transplantation between 2000 and 2010 were enrolled. Specific immunosuppressive users are defined as sustained use (more than 12 months) after renal transplantation. The primary outcome is the development of cancer after kidney transplantation. A Cox proportional hazards model was used to determine the risk of cancer development. RESULT: Among 4438 recipients, 559 of them were diagnosed with malignancy after 1 year of transplantation. A total of 742 of recipients were as user of mechanistic target of rapamycin (mTOR) inhibitors. The mTOR users had higher rate of receiving pulse therapy. The hazard ratios (HR) for mTOR inhibitor users with exposure more than 5 years for overall malignancy and urothelial malignancy were 0.68 (95% CI: 0.48-0.95, P = 0.02) and 0.60 (95% CI: 0.36-0.99, P = 0.02), respectively. For the overall mortality and reentry of dialysis, the probability of both groups was similar (overall mortality: P = 0.53; reentry of dialysis: P = 0.77). CONCLUSION: Among the recipients of renal transplantation in Taiwan, mTOR inhibitors with exposure more than 5 years provided a protective role in reducing the risk of overall neoplasm and urothelial malignancy. The probability of reentry of dialysis and overall mortality was similar between the mTORi users and nonusers. CI - (c) 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. FAU - Hou, Yi-Chou AU - Hou YC AUID- ORCID: 0000-0001-7662-9890 AD - Division of Nephrology, Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan. AD - Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. FAU - Chang, Yen-Chen AU - Chang YC AD - Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan. FAU - Luo, Hao-Lun AU - Luo HL AD - Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. AD - Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan. FAU - Lu, Kuo-Cheng AU - Lu KC AD - Division of Nephrology, Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan. AD - Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. AD - Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. FAU - Chiang, Po-Huang AU - Chiang PH AD - Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20180816 PL - United States TA - Cancer Med JT - Cancer medicine JID - 101595310 RN - 0 (Immunosuppressive Agents) RN - 0 (Protein Kinase Inhibitors) RN - EC 2.7.11.1 (TOR Serine-Threonine Kinases) SB - IM MH - Adult MH - Aged MH - Comorbidity MH - Female MH - Humans MH - Immunosuppressive Agents/adverse effects/therapeutic use MH - Incidence MH - Kaplan-Meier Estimate MH - Kidney Transplantation/*adverse effects MH - Male MH - Middle Aged MH - Neoplasms/*epidemiology/*etiology MH - Prognosis MH - Protein Kinase Inhibitors/*adverse effects/therapeutic use MH - Risk Assessment MH - Risk Factors MH - TOR Serine-Threonine Kinases/*antagonists & inhibitors/metabolism MH - Young Adult PMC - PMC6144254 OTO - NOTNLM OT - malignancy OT - mechanistic target of rapamycin inhibitor OT - renal transplantation EDAT- 2018/08/18 06:00 MHDA- 2019/11/15 06:00 PMCR- 2018/08/16 CRDT- 2018/08/18 06:00 PHST- 2018/03/05 00:00 [received] PHST- 2018/06/16 00:00 [accepted] PHST- 2018/08/18 06:00 [pubmed] PHST- 2019/11/15 06:00 [medline] PHST- 2018/08/18 06:00 [entrez] PHST- 2018/08/16 00:00 [pmc-release] AID - CAM41676 [pii] AID - 10.1002/cam4.1676 [doi] PST - ppublish SO - Cancer Med. 2018 Sep;7(9):4296-4307. doi: 10.1002/cam4.1676. Epub 2018 Aug 16.