A 50-year-old patient on immunosuppression post-renal transplant is found to have a cutaneous squamous cell carcinoma (SCC). This is being attributed to post-transplant immunosuppression. Which immunosuppressant, when substituted for calcineurin inhibitors, has been shown to reduce de novo malignancy risk after organ transplantation?
- A mTOR inhibitors (sirolimus, everolimus) ✓
- B Mycophenolate mofetil
- C Azathioprine
- D Belatacept
Explanation
mTOR inhibitors (sirolimus, everolimus) have intrinsic anti-proliferative and anti-angiogenic properties through inhibition of mTORC1, which is involved in cell cycle progression and tumour angiogenesis. Multiple studies and the CONVERT trial have shown that converting stable transplant recipients from calcineurin inhibitors to mTOR inhibitor-based regimens reduces the incidence of post-transplant malignancy, particularly skin cancers and Kaposi's sarcoma. This property is not shared by mycophenolate, azathioprine, or belatacept. The tradeoff is a higher risk of proteinuria, impaired wound healing, and dyslipidaemia with mTOR inhibitors.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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