117700 20240319081010.0 doi 10.1111/ajt.17021 sideral 129247 ART-2022-129247 eng Rodriguez-Peralvarez, Manuel Cumulative exposure to tacrolimus and incidence of cancer after liver transplantation 2022 Access copy available to the general public Unrestricted Cancer is the leading cause of death after liver transplantation (LT). This multicenter case-control nested study aimed to evaluate the effect of maintenance immunosuppression on post-LT malignancy. The eligible cohort included 2495 LT patients who received tacrolimus-based immunosuppression. After 13 922 person/years follow-up, 425 patients (19.7%) developed malignancy (cases) and were matched with 425 controls by propensity score based on age, gender, smoking habit, etiology of liver disease, and hepatocellular carcinoma (HCC) before LT. The independent predictors of post-LT malignancy were older age (HR = 1.06 95% CI 1.05-1.07]; p < .001), male sex (HR = 1.50 95% CI 1.14-1.99]), smoking habit (HR = 1.96 95% CI 1.42-2.66]), and alcoholic liver disease (HR = 1.53 95% CI 1.19-1.97]). In selected cases and controls (n = 850), the immunosuppression protocol was similar (p = .51). An increased cumulative exposure to tacrolimus (CET), calculated by the area under curve of trough concentrations, was the only immunosuppression-related predictor of post-LT malignancy after controlling for clinical features and baseline HCC (CET at 3 months p = .001 and CET at 12 months p = .004). This effect was consistent for de novo malignancy (after excluding HCC recurrence) and for internal neoplasms (after excluding non-melanoma skin cancer). Therefore, tacrolimus minimization, as monitored by CET, is the key to modulate immunosuppression in order to prevent cancer after LT. info:eu-repo/semantics/openAccess by-nc-nd http://creativecommons.org/licenses/by-nc-nd/3.0/es/ 8.7 2022 TRANSPLANTATION 2 / 26 = 0.077 2022 Q1 T1 SURGERY 8 / 213 = 0.038 2022 Q1 T1 2.776 2022 Immunology and Allergy 2022 Q1 Transplantation 2022 Q1 Pharmacology (medical) 2022 Q1 15.9 2022 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Colmenero, Jordi Gonzalez, Antonio Gastaca, Mikel Curell, Anna Caballero-Marcos, Aranzazu Sanchez-Martinez, Ana Di Maira, Tommaso Ignacio Herrero, Jose Almohalla, Carolina Lorente Pérez, Sara Universidad de Zaragoza (orcid)0000-0003-4672-8083 Cuadrado-Lavin, Antonio Pascual, Sonia Angeles Lopez-Garrido, Maria Gonzalez-Grande, Rocio Gomez-Orellana, Antonio Alejandre, Rafael Zamora-Olaya, Javier Bernal-Bellido, Carmen 1007 610 Universidad de Zaragoza Dpto. Medicina, Psiqu. y Derm. Area Medicina 22, 6 (2022), 1671-1682 AM J TRANSPLANT AMERICAN JOURNAL OF TRANSPLANTATION 1600-6135 1990099 http://zaguan.unizar.es/record/117700/files/texto_completo.pdf Versión publicada 2244111 http://zaguan.unizar.es/record/117700/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:117700 articulos driver 2024-03-18-15:04:03 ARTICLE