14 November 2017 : Original article
Tacrolimus Levels Are Not Associated with Risk of Malignancy in Lung Transplant Recipients
Benjamin Daniel Fox12ABCDEF*, Fadi Ashquar1BCE, Yael Raviv12ABEF, Dror Rozengarten12BCDE, Osnat Straichman12DEF, Shimon Izhakian1BE, Mordechai Reuven Kramer12AEFDOI: 10.12659/AOT.904417
Ann Transplant 2017; 22:677-681
Abstract
BACKGROUND: Lung transplant (LTx) recipients suffer from high rates of malignancy. Exposure to immunosuppressive medication such as tacrolimus has been proposed as a risk factor for tumorigenesis. We hypothesized that chronically high levels of tacrolimus would be associated with risk of malignancy.
MATERIAL AND METHODS: The study was performed in a transplant center in Israel, with a nested case-control design. Cases were LTx recipients who were diagnosed with any solid or hematological malignancy except non-melanoma skin cancer. Controls were tumor-free during their entire follow-up after LTx and had at least the same follow-up time as their matched case. Controls were matched to cases by age and type of transplant received (single/double). Tacrolimus levels were extracted and analyzed for median drug level and also integrated over time (area under the curve – AUC-tacrolimus).
RESULTS: We reviewed 412 LTx recipients in our registry. Thirty-nine cases of malignancy were diagnosed and 160 controls were matched, giving a crude tumor incidence rate of 26/100 000/year. Lung cancers were the commonest diagnosis. Cases and controls were well matched by age, smoking status, and LTx type. Median tacrolimus levels were 11.0 ng/ml and 11.3 ng/ml in cases and controls, respectively (p=0.88). The median log (AUC-tacrolimus) was 9.4 in the cases and 9.5 in the controls (p=0.59).
CONCLUSIONS: In this nested case-control study, exposure to tacrolimus was similar in tumor cases and non-tumor controls. These data, based on a cohort with modest size, suggest either that tumorigenesis in LTx recipients is unrelated to tacrolimus exposure or that levels in these patients are above an unknown threshold at which the dose-response effect is saturated.
Keywords: carcinogenesis, Case-Control Studies, Neoplasms, Immunosuppressive Agents, Lung Transplantation, Tacrolimus
In Press
Original article
Retrospective Study to Compare Outcomes in 159 Patients Undergoing First Autologous Stem Cell Transplantati...Ann Transplant In Press; DOI: 10.12659/AOT.947186
Case report
Pulmonary Embolism Following Living Donor Hepatectomy: A Report of 4 Cases and Literature ReviewAnn Transplant In Press; DOI: 10.12659/AOT.946752
Most Viewed Current Articles
03 Jan 2023 : Original article 6,487
Impact of Autologous Stem Cell Transplantation on Primary Central Nervous System Lymphoma in First-Line and...DOI :10.12659/AOT.938467
Ann Transplant 2023; 28:e938467
16 May 2023 : Original article 6,127
Breaking Antimicrobial Resistance: High-Dose Amoxicillin with Clavulanic Acid for Urinary Tract Infections ...DOI :10.12659/AOT.939258
Ann Transplant 2023; 28:e939258
15 Aug 2023 : Review article 6,125
Free-Circulating Nucleic Acids as Biomarkers in Patients After Solid Organ TransplantationDOI :10.12659/AOT.939750
Ann Transplant 2023; 28:e939750
17 Jan 2023 : Original article 5,250
Non-Cryopreserved Peripheral Blood Stem Cell Graft for Autologous Hematopoietic Stem Cell Transplantation i...DOI :10.12659/AOT.938595
Ann Transplant 2023; 28:e938595