Immunosuppressive regimens and skin cancer risk in solid-organ transplant recipients
Gómez-Tomás, Álvaro (Universitat Autònoma de Barcelona. Departament de Medicina)
González-Cruz, Carlos (Hospital Universitari Vall d'Hebron)
García-Patos Briones, Vicente (Universitat Autònoma de Barcelona. Departament de Medicina)
Ferrandiz-Pulido, Carla (Universitat Autònoma de Barcelona. Departament de Medicina)

Fecha:	2026
Resumen:	Background: Solid organ transplant recipients (SOTRs) are at increased risk of developing skin cancer due to long-term immunosuppressive (IS) therapy. Calcineurin inhibitors (CNIs), particularly tacrolimus and ciclosporin, are associated with elevated skin cancer risk. Mammalian -target of rapamycin inhibitors (mTORis) are considered protective, but real-life evidence of their effectiveness, especially when combined with reduced-dose CNIs, is limited. Understanding the impact of current IS regimens on skin cancer risk is essential for improving patient outcomes. Objectives: To evaluate the relative risk of different IS drugs and regimens on skin cancer development in SOTRs. Methods: We conducted a prospective observational study at Vall d'Hebron University Hospital, Barcelona, Spain, from 2011 to 2021. The study included 1055 SOTRs from a mixed-organ cohort, with a combined follow-up of 3336 person-years. Real-life IS drug regimens were recorded during scheduled posttransplant screenings or dermatological follow-ups. Cox proportional hazards models with shared frailty were used to assess skin cancer risk, accounting for multiple events and adjusting for time-varying drug exposure. Results: Skin cancer occurred in 131 of 1055 SOTRs (12. 4%). A total of 450 skin cancer events were registered, including 317 squamous cell carcinomas (70%), 118 basal cell carcinomas (26%) and 15 melanomas (3%). mTORi-based regimens were associated with significantly lower skin cancer rates [hazard ratio (HR) 0. 66, 95% confidence interval (CI) 0. 47-0. 92; P = 0. 01]. Everolimus appeared more protective than sirolimus (HR 0. 38, 95% CI 0. 21-0. 69; P < 0. 001). Reduced-dose CNIs combined with mTORis were linked to a 37% reduction in skin cancer rates in high-risk patients (HR 0. 63, 95% CI 0. 42-0. 93; P = 0. 02) and a 32% reduction in patients with posttransplant events (HR 0. 68, 95% CI 0. 47-0. 98; P = 0. 04). The reduction was mainly driven by decreased squamous cell carcinoma incidence. Conclusions: mTORi-based regimens, particularly with reduced-dose tacrolimus, appear to offer a safer and more effective alternative to CNI-heavy regimens for skin cancer prevention in SOTRs. Real-life data support the integration of mTORis into IS strategies to reduce skin cancer risk, particularly for high-risk patients and those who developed skin malignancies. An author video to accompany this article is available online.
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Lengua:	Anglès
Documento:	Article ; recerca ; Versió acceptada per publicar
Publicado en:	British journal of dermatology, Vol. 194, Num. 4 (March 2026) , p. 747-757, ISSN 1365-2133

DOI: 10.1093/bjd/ljaf483

Disponible a partir de: 2027-03-31 20 p, 594.8 KB

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