Sirolimus and Non-melanoma Skin Cancer Prevention after Kidney Transplantation: A Meta-analysis

Background: Whether sirolimus is useful in the prevention of non-melanoma skin cancer (NMSC) remainsunclear and we therefore performed this meta-analysis of randomized controlled trials to test the hypothesis thatSirolimus-based immunosuppression is associated with a decrease in NMSC.
Methods: The main outcomes wereNMSC, squamous-cell carcinoma and basal-cell carcinoma. The pooled risk ratio (RR) with its 95% confidenceinterval (95%CI) were used to assess the effects.
Results: 5 randomized trials involving a total of 1499 patientsreceiving kidney transplantation were included. Patients undergoing Sirolimus-based immunosuppression hadmuch lower risk of NMSC (RR = 0.49, 95%CI 0.32-0.76, P = 0.001). Subgroup analyses by tumor type showedthat Sirolimus-based immunosuppression significantly decreased risk of both squamous-cell carcinoma (RR= 0.58, 95%CI 0.43-0.78, P < 0.001) and basal-cell carcinoma (RR = 0.56, 95%CI 0.37-0.85, P = 0.006). Thequality of evidence was high for NMSC, and moderate for squamous-cell carcinoma and basal-cell carcinoma.No evidence of publication bias was observed.
Conclusion: High quality evidence suggests that Sirolimus-basedimmunosuppression decreases risk of non-melanoma skin cancer, and Sirolimus has an antitumoral effect amongkidney-transplant recipients.