Associations of Mammalian Target of Rapamycin Inhibitors with Post-Transplant Malignancies and All-Cause Mortality: Cause-Specific Competing Risks and Composite Outcomes Analyses

A. H. Santos¹, E. Bueno¹, M. A. Leghrouz¹, W. Xuerong²

¹University of Florida, Gainesville, FL, ²University of Rhode Island, Kingston, RI

Meeting: 2021 American Transplant Congress

Abstract number: 457

Keywords: Kidney transplantation, Malignancy, Mortality, Sirolimus (SLR)

Topic: Clinical Science » Organ Inclusive » Non-PTLD/Malignancies

Session Information

Session Name: Organ Inclusive

Session Type: Poster Video Chat

Date: Monday, June 7, 2021

Session Time: 7:30pm-8:30pm

Presentation Time: 7:50pm-8:00pm

Location: Virtual

*Purpose: We investigated the outcomes of malignancies and mortality associated with mammalian target of rapamycin inhibitor (MTORI) regimens in adult kidney transplant (KT) recipients (KTRs).

*Methods: Using year 2000-2018 SRTR data, we compared the risks of non-melanoma skin cancer (NMSC), solid-organ malignancy (SOM), and lymphoma associated with 1st transplant-yr. exposure to MTORI regimens [sirolimus or everolimus combined with a calcineurin inhibitor (CNI), mycophenolate, or azathioprine) with or without steroids versus non-MTORI regimens (any CNI, mycophenolate, or azathioprine 2-drug combination) with or without steroids in adult-KTRs.

*Results: Among 166,256 adult KTRs studied; 13,056 (7.9%) were on MTORI and 153,200 (92.2%) were on non-MTORI. Except for induction, standardized differences of baseline risk factors were not significant between groups. Over a maximum 5 years of follow-up, the adjusted risks of NMSC, SOM, and lymphoma were 30% (95% CI=24%-36%); 14% (95% CI=7%-20%); and 20% (95% CI=3%-34%) lower with MTORI than non-MTORI regimens, respectively. However, the adjusted risk of all-cause death (as a cause-specific competing event) was higher with MTORI than non-MTORI regimens (Fig. 1). The adjusted risks of composite all-cause death (ACD) or NMSC, ACD or SOM, and ACD or lymphoma were 8% (95% CI=4%-11%); 12% (95% CI=8%-12%); and 17%(13%-21%) higher with MTORI than non-MTORI regimens, respectively (Fig. 2).

*Conclusions: MTORI regimens are associated with lower risks of malignancies but higher risk of all-cause death than non-MTORI regimens in adult KTRs. The underlying reasons for these findings need further investigation.

To cite this abstract in AMA style:

Santos AH, Bueno E, Leghrouz MA, Xuerong W. Associations of Mammalian Target of Rapamycin Inhibitors with Post-Transplant Malignancies and All-Cause Mortality: Cause-Specific Competing Risks and Composite Outcomes Analyses [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/associations-of-mammalian-target-of-rapamycin-inhibitors-with-post-transplant-malignancies-and-all-cause-mortality-cause-specific-competing-risks-and-composite-outcomes-analyses/. Accessed May 16, 2025.

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