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Meta-Analysis
. 2023 Jun 13;30(6):5727-5737.
doi: 10.3390/curroncol30060430.

Systematic Review of Calcineurin Inhibitors and Incidence of Skin Malignancies after Kidney Transplantation in Adult Patients: A Study of 309,551 Cases

Aleksandra Kulbat  1   2   3 , Karolina Richter  4 , Tomasz Stefura  2   3 , Marta Kołodziej-Rzepa  2   4 , Michał Kisielewski  2   4 , Tomasz Wojewoda  2   4 , Wojciech M Wysocki  1   2   4
Affiliations
Meta-Analysis

Systematic Review of Calcineurin Inhibitors and Incidence of Skin Malignancies after Kidney Transplantation in Adult Patients: A Study of 309,551 Cases

Aleksandra Kulbat et al. Curr Oncol. .

Abstract

The purpose of this systematic review and meta-analysis was to compare the risk of non-melanoma skin cancer (NMSC) and melanoma development in renal transplant recipients who receive calcineurin inhibitors to that of patients treated with other immunosuppressive agents, and investigate the possible association between the type of maintenance immunosuppression and the incidence of NSMC and melanoma in this group of patients. The authors searched databases such as PubMed, Scopus, and Web of Science for articles that would help establish the influence of calcineurin inhibitors on skin cancer development. The inclusion criteria for the study consisted of randomized clinical trials, cohort studies, and case-control studies that compared patients who received kidney transplants and were treated with a calcineurin inhibitor (CNI), such as cyclosporine A (CsA) or tacrolimus (Tac), to those who received alternative immunosuppressants and did not receive a CNI. Seven articles were analyzed overall. The results revealed a correlation between CNI treatment in renal transplant recipients and increased total skin cancer risk (OR 1.28; 95% CI: 0.10-16.28; p < 0.01), melanoma risk (OR 1.09; 95% CI: 0.25-4.74; p < 0.01), and NMSC risk (OR 1.16; 95% CI: 0.41-3.26; p < 0.01). In conclusion, the calcineurin inhibitors used after kidney transplantation are associated with a higher risk of skin cancer-both non-melanoma and melanoma-when compared with other immunosuppressive therapies. This finding suggests that careful monitoring for skin lesions in post-transplant patients must be conducted. However, the decision on the kind of immunotherapy used should always be considered on an individual basis for each renal transplant recipient.

Keywords: calcineurin inhibitors; cyclosporine; melanoma skin cancer; meta-analysis; non-melanoma skin cancer; renal transplant recipients; renal transplantation; skin cancer; tacrolimus.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of the study inclusion process.
Figure 2
Figure 2
Melanoma risk [19,20,23].
Figure 3
Figure 3
Non-melanoma skin cancer risk [19,21,23,24,25].
Figure 4
Figure 4
Total skin cancer risk [19,22,23].
Figure 5
Figure 5
Quality assessment−Cochrane risk-of-bias tool for randomized trials (RoB 2) [19,20,21,22,23,24,25].
See this image and copyright information in PMC

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