Background: The CONVERT trial found a reduced incidence of malignancy amongst renal transplant recipients over 2 years of follow up with a conversion from calcineurin inhibitors to sirolimus based immunosuppression. Common reasons for considering this switch are calcineurin inhibitor toxicity and high skin cancer burden. Whether this strategy results in reduced skin cancer incidence over longer term follow up, has not been extensively characterised.

Methods: A retrospective study of sirolimus conversion within the Irish National Kidney Transplant programme from 1994 to 2015. These data were linked with the Irish National Cancer Registry to determine the incidence of non-melanomatous skin cancer (NMSC) amongst these recipients.

Results: 127 renal transplant recipients were transitioned from a calcineurin inhibitor to sirolimus. The incidence of NMSC before switching was 89 per 1000 patient years with an incidence of 45 per 1000 patient years after switching. Incidence rate ratio [Sirolimus vs Calcineurin] 0.50 (0.34, 0.74) P<0.001. See Figure 1.

Conclusions: Conversion of maintenance immunosupression from calcineurin inhbitors to sirolimus in clinical practice, outside of a randomized trial context, did in fact appear to reduce the incidence of NMSC skin cancer in kidney transplant recipients.

Figure 1. Distribution of non-melanoma skin cancer before and after switching from Calcineurin inhibitors to Sirolimus.

CITATION INFORMATION: Daly F., O'Kelly P., Moloney F., Sexton D., Conlon P. The Influence of a Conversion to Sirolimus-Based Immunosuppression on Non-Melanomatous Skin Cancer Incidence in Kidney Transplant Recipients over Long Term Follow Up Am J Transplant. 2017;17 (suppl 3).

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