LJ JAMES1,2, V SAGLIMBEBE1,3, G WONG1,2,3, A TONG1,2, L LUU1,2, JC CRAIG1,2, M HOWELL1,2
1Sydney School of Public Health, The University of Sydney, Sydney, Australia, 2Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia, 3Diaverum Medical-Scientific Office, Lund, Sweden, 4Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia
Background: Strategies for skin cancer prevention are recommended in solid organ transplant recipients.
Aim: To determine the effectiveness of behavioral and pharmaceutical interventions for skin cancer prevention in solid organ transplant recipients.
Methods: We searched electronic databases of RCTs that assessed the effectiveness of behavioral and pharmaceutical preventive interventions for skin cancer in solid organ transplant recipients from inception to January 2018. We conducted a risk of bias assessment and assessed confidence in the evidence using the GRADE framework.
Results: Twenty reports of 19 RCTs with 2,273 participants were included. The overall risk of bias was high or unclear and quality of evidence was very low. Compared with standard care, participants who received behavioral interventions reported improvement in sun protection behavior (3 studies, n= 414, SMD 0.70, 95% CI 0.48-0.92, I2 =99%) and knowledge (5 studies, n=589, SMD 0.73, 95% CI 0.56-0.90, I2= 85%). Participants who were converted from calcineurin inhibitors (CNI) based therapy to mTOR inhibitors experienced at least a 50% reduction in the overall incidence of non-melanocytic skin cancer (NMSC) (5 studies, n= 1096, RR 0.50 95% CI 0.41-0.62, I2 =72%) compared to those maintained on CNI. A reduction in the overall incidence of actinic keratosis was reported in recipients who received photodynamic therapy (2 studies, n=50, RR 2.44, 95% CI 1.41-4.22, I2 85%) compared to placebo or a topical immune response modifier cream. Heterogeneity was partially explained by variability in the study same, trial duration and quality of the studies.
Conclusion: Preventive interventions may improve sun protective behavior and reduce the incidence of NMSCs in solid organ transplant recipients. However, the quality of evidence is low, therefore the treatment effects are uncertain.