Cancer and mTOR inhibitors in kidney transplantation recipients

Chih-Chin Kao; Jia-Sin Liu; Yu-Kang Chang; Ming-Huang Lin; Yen-Chung Lin; Hsi-Hsien Chen; Wei-Chiao Chang; Chih-Cheng Hsu; Mai-Szu Wu

doi:10.7717/peerj.5864

Cancer and mTOR inhibitors in kidney transplantation recipients

PeerJ. 2018 Nov 8:6:e5864. doi: 10.7717/peerj.5864. eCollection 2018.

Authors

Chih-Chin Kao^{1

2

3}, Jia-Sin Liu⁴, Yu-Kang Chang⁵, Ming-Huang Lin⁴, Yen-Chung Lin^{1

2

3}, Hsi-Hsien Chen^{2

3}, Wei-Chiao Chang^{6

7}, Chih-Cheng Hsu^{4

8}, Mai-Szu Wu^{1

3

9}

Affiliations

¹ Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
² Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
³ Department of Internal Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan.
⁴ Division of Geriatrics and Gerontology, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
⁵ Department of Medical Research, Tungs' Taichung Metroharbor Hospital, Wuchi, Taichung, Taiwan.
⁶ Department of Clinical Pharmacy, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁷ Master Program for Clinical Pharmacogenomics and Pharmacoproteomics, School of Pharmacy, Taipei Medical University, Taipei, Taiwan.
⁸ Department of Health Services Administration, China Medical University, Taichung, Taiwan.
⁹ Division of Nephrology, Department of Internal Medicine, Shuang-Ho Hospital, New Taipei City, Taiwan.

Abstract

Background: Previous studies show that mTOR inhibitors decrease the risk of cancer development after kidney transplantation. However, the effect of cumulative doses of mTOR inhibitors on cancer after kidney transplantation is not well known.

Methods: In the current study, patients were registered into a national database in Taiwan. Between year 2000 and 2013, 4,563 patients received kidney transplantation. They were divided into two groups, according to mTOR inhibitors usage. The cumulative dose of mTOR inhibitors was recorded. Patients were followed-up until de novo cancer development, death, or the end of 2014.

Results: Patients were divided into two groups: mTOR inhibitors users (study group, n = 828) and mTOR inhibitors non-users (control group, n = 3,735). The median follow-up duration was 7.8 years. The risk of de novo cancer (hazards ratio (HR) 0.80, 95% CI [0.60-1.09], p = 0.16) and risk of death (HR 1.14, 95% CI [0.82-1.60], p = 0.43) was not different between mTOR inhibitor user and non-user groups. Neither high- nor low-dose exposure to mTOR inhibitors was associated with increased risk of cancer or mortality. Analysis of cancer subtypes showed no influence by mTOR inhibitors. In addition, the cause of mortality was not significantly different between the two groups.

Discussion: We could not find the association of mTOR inhibitors use and risk of de novo cancer development or mortality in patients with kidney transplantation in Chinese patients. Cumulative exposure to mTOR inhibitors did not change the results.

Keywords: Cancer; Chronic kidney disease; Kidney transplantation; Mortality; mTOR inhibitors.

Grants and funding

This study was supported by grants from: the Health Promotion Administration and the Health and Welfare Surcharge of Tobacco Products, Ministry of Health and Welfare, Taiwan; and the Ministry of Science and Technology, R.O.C. (MOST 105-2314-B-038-050-MY3). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.