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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Immunosuppressive treatment and radiotherapy in kidney transplant patients: A systematic review
Valentina Lancellotta, Andrea D'Aviero, Bruno Fionda, Calogero Casà, Ilaria Esposito, Francesco Preziosi, Anna Acampora, Fabio Marazzi, György Kovács, Barbara Alicja Jereczek-Fossa, Alessio Giuseppe Morganti, Vincenzo Valentini, Maria Antonietta Gambacorta, Jacopo Romagnoli, Luca Tagliaferri
Valentina Lancellotta, Andrea D'Aviero, Bruno Fionda, Calogero Casà, Ilaria Esposito, Francesco Preziosi, Fabio Marazzi, Vincenzo Valentini, Maria Antonietta Gambacorta, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
Anna Acampora, Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome 00168, Rome, Italy
György Kovács, Università Cattolica del Sacro Cuore, Gemelli-INTERACTS, Rome, 00168 Rome, Italy
Barbara Alicja Jereczek-Fossa, Department of Oncology and Hemato-oncology, European Institute of Oncology, University of Milan, Milan 20141, Italy
Alessio Giuseppe Morganti, Radiotherapy Center, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40121, Italy
Jacopo Romagnoli, Luca Tagliaferri, Renal Transplant Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Rome, Italy
Author contributions: Valentini V, Morganti AG, Tagliaferri L, and Romagnoli J contributed to scientific committee; Acampora A, Lancellotta V, and Tagliaferri L contributed to working group performing literature review and summary for experts; Romagnoli J, Marazzi F, Preziosi F, Casà C, and Esposito I contributed to resolve uncertainty regarding eligibility; Kovács G, Jereczek-Fossa A, and Gambacorta MA contributed to revise the manuscript.
Conflict-of-interest statement: the authors reported no potential competing interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Bruno Fionda, MD, Doctor, UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, Romre 00168, Rome, Italy. bruno.fionda@yahoo.it
Received: October 11, 2021
Peer-review started: October 11, 2021
First decision: December 10, 2021
Revised: December 20, 2021
Accepted: March 15, 2022
Article in press: March 15, 2022
Published online: March 28, 2022
Processing time: 164 Days and 23.4 Hours
ARTICLE HIGHLIGHTS
Research background
Cancer is the second most common cause of mortality and morbidity in kidney transplant recipients. Immunosuppression can influence the efficacy of cancer treatment and modification of the immunosuppressive regimen may restore anti-neoplastic immune responses improving oncologic prognosis. However, patients are usually reluctant to modify their immunosuppression, fearing rejection and potential graft loss.
Research motivation
To develop reference points for guiding the transplant professionals in the clinical decision-making process and to improve the management of kidney transplant recipients with cancer.
Research objectives
Little evidence is available on radiotherapy management of cancer in kidney transplant recipients; in certain instances (e.g., in case of pelvic cancer or cancer of the transplanted kidney) it is also unclear which could be the best loco-regional treatment option, among the full range of ablative devices/ techniques, to be used as an alternative to nephron sparing surgery, currently the preferred option.
Research methods
The overall process included: (1) The formulation of one specific question based on the Population, Intervention, Comparison, and Outcomes methodology; (2) Systematic literature review and summary for experts for each question; and (3) Extracted data were narratively synthesized and, where possible, frequencies, percentages, and ranges were calculated.
Research results
There is still no clear evidence that withdrawing anti-metabolites and/or calcineurin inhibitor and/or mammalian target of rapamycin inhibitors as opposed to continuing maintenance immunosuppression might improve patient survival in kidney transplant recipients with cancer undergoing radiotherapy. There are few retrospective studies on small cancer cohorts undergoing radiotherapy, especially prostate, without comparison of different immunosuppressive treatments. The radiation therapy can be performed with excellent oncological outcomes. No studies have compared different immunosuppressive treatment, and, when the immunosuppressive drugs are reported, patients’ survival seems to be correlated only with cancer stage or type. In addition, there are no data on the eventual effects of immunosuppressive drugs, especially mammalian target of rapamycin inhibitors, on the healing of radiotherapy-induced skin toxicity.
Research conclusions
Although all the statements of the consensus are not methodologically evidence-based and their strength might therefore be questionable, they represent a starting point to orient transplant physicians in their everyday practice, and, above all, these statements clearly indicate the points that need to be addressed in the clinical research in this setting.
Research perspectives
Prospective studies or pooled analyses are needed to define the proper treatment for this very selected group of patients.
