{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:51:13Z","timestamp":1787028673099,"version":"build-2736575974"},"reference-count":14,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2019,12,11]],"date-time":"2019-12-11T00:00:00Z","timestamp":1576022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The risk of cancer increases after transplantation. However, the consensus on immunosuppression (IS) adjustment after diagnosis of malignancy is lacking. Our study aims to assess the impact of IS adjustment on mortality of post-kidney transplant patients and allograft outcomes. We retrospectively reviewed the data in our center of 110 subjects. Our results showed IS dose adjustment was not statistically associated with mortality risk (HR 1.94, 95%CI 0.85\u20134.41, p = 0.12), and chemotherapy was the only factor that was significantly related to mortality (HR 2.3, 95%CI 1.21\u20134.35, p = 0.01). IS reduction was not statistically associated with worsening graft function (OR 3.8, 95%CI 0.77\u201318.71, p = 0.10), nor with graft survival (SHR 4.46, 95%CI 0.58\u201334.48, p = 0.15) after variables adjustment. Creatinine at cancer diagnosis and history of rejection were both negatively associated with graft survival (SHR 1.72, 95%CI 1.28\u20132.30, p &lt; 0.01 and SHR 3.44, 95%CI 1.25\u20139.49, p = 0.02). Reduction of both mycophenolate and calcineurin inhibitors was associated with worsening graft function and lower graft survival in subgroup analysis (OR 6.14, 95%CI 1.14\u201333.15, p = 0.04; HR 17.97, 95%CI 1.81\u2013178.78, p = 0.01). In summary, cancer causes high mortality and morbidity in kidney transplant recipients; the importance of cancer screening should be emphasized.<\/jats:p>","DOI":"10.3390\/jcm8122189","type":"journal-article","created":{"date-parts":[[2019,12,12]],"date-time":"2019-12-12T03:20:16Z","timestamp":1576120816000},"page":"2189","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Management of Immunosuppression in Kidney Transplant Recipients Who Develop Malignancy"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4620-495X","authenticated-orcid":false,"given":"Danwen","family":"Yang","sequence":"first","affiliation":[{"name":"Division of Nephrology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9108-7559","authenticated-orcid":false,"given":"Natanong","family":"Thamcharoen","sequence":"additional","affiliation":[{"name":"Section of Palliative Care, Division of General Medicine and Division of Nephrology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4723-9583","authenticated-orcid":false,"given":"Francesca","family":"Cardarelli","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,12,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1111\/j.1600-6143.2010.03181.x","article-title":"Comparison of the incidence of malignancy in recipients of different types of organ: A UK registry audit","volume":"10","author":"Collett","year":"2010","journal-title":"Am. 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Proc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"g6679","DOI":"10.1136\/bmj.g6679","article-title":"Effect of sirolimus on malignancy and survival after kidney transplantation: Systematic review and meta-analysis of individual patient data","volume":"349","author":"Knoll","year":"2014","journal-title":"BMJ"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1097\/TP.0b013e3181d62f1b","article-title":"The KDIGO clinical practice guidelines for the care of kidney transplant recipients","volume":"89","author":"Chapman","year":"2010","journal-title":"Transplantation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"c570","DOI":"10.1136\/bmj.c570","article-title":"Effect of reduced immunosuppression after kidney transplant failure on risk of cancer: Population based retrospective cohort study","volume":"340","author":"Webster","year":"2010","journal-title":"BMJ"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1681\/ASN.2015040373","article-title":"Variation in Cancer Incidence among Patients with ESRD during Kidney Function and Nonfunction Intervals","volume":"27","author":"Yanik","year":"2016","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1111\/tri.12638","article-title":"Reductions in immunosuppression after haematological or solid organ cancer diagnosis in kidney transplant recipients","volume":"28","author":"Hope","year":"2015","journal-title":"Transpl. Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4464","DOI":"10.1093\/ndt\/gfs386","article-title":"Reduced survival and quality of life following return to dialysis after transplant failure: The Dialysis Outcomes and Practice Patterns Study","volume":"27","author":"Perl","year":"2012","journal-title":"Nephrol. Dial. Transplant."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/12\/2189\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:41:34Z","timestamp":1760190094000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/12\/2189"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,11]]},"references-count":14,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2019,12]]}},"alternative-id":["jcm8122189"],"URL":"https:\/\/doi.org\/10.3390\/jcm8122189","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12,11]]}}}