E CHUNG1,S PALMER2, G STRIPPOLI3,4,5,6
1Royal North Shore Hospital, Sydney, Australia, 2University of Otago , Christchurch, New Zealand, 3University of Sydney, Sydney , Australia, 4Cochrane Kidney and Transplant, Westmead, Australia, 5University of Bari, Bari, Italy, 6Medical Scientific Office and Diaverum Academy, Diaverum, Sweden
Aim: We did a systematic review with meta-analysis to summarise the benefits and harms of interventions used to prevent non-melanoma skin cancer following solid organ transplantation and to evaluate the certainty of the available evidence.
Background: Organ transplant recipients have a much higher risk of developing skin cancer than the general population.
Methods: We searched MEDLINE, Embase and CENTRAL through to 16 December 2017 for randomised controlled trials evaluating interventions to prevent non-melanoma skin cancer in organ transplant recipients. One author independently selected eligible studies and extracted data. Risk of bias were assessed using the Cochrane tool and evidence certainty was evaluated using the GRADE process. Outcomes were non-melanoma skin cancer, keratotic skin lesions, the Standardised Outcomes in Nephrology-transplant core outcomes (graft function, all-cause mortality, cardiovascular events, infection, life participation) and intervention-specific adverse events.
Results: Fourteen trials (420 participants) met eligibility criteria. Compared to placebo or no treatment, any intervention (acitretin, imiquimod, nicotinamide [2 trials, 60 participants, relative risk (RR) 0.67, 95% confidence interval (CI) 0.05-8.87], or photodynamic therapy [3 trials, 93 participants, RR 1.40, CI 0.65-3.02]) had uncertain effects on risk of non-melanoma skin cancers. Effects of any intervention on graft function were uncertain though most trials were not designed to assess treatment effects on graft function, all-cause mortality, cardiovascular events, infection or life participation. Moderate-quality evidence indicated imiquimod did not reduce mortality (2 trials, 63 participants, RR 0.67, CI 0.05-8.87). In low-quality evidence, photodynamic therapy may prevent keratotic skin lesions (2 trials, 53 participants, RR 0.24, CI 0.12-0.48).
Conclusions: It is uncertain whether any intervention prevents non-melanoma skin cancers among solid organ transplant recipients or impacts graft function.
Edmund Chung is currently a first year renal advanced trainee in the East Coast Network, NSW. He completed his undergraduate BMed MD at UNSW and postgraduate MMed (ClinEpi) at the University of Sydney. He has performed systematic reviews with the Cochrane Kidney and Transplant group and is passionate about better understanding how to limit the progression of chronic kidney disease.