Interventions to Prevent Nonmelanoma Skin Cancers in Recipients of a Solid Organ Transplant: Systematic Review of Randomized Controlled Trials.Chung, E. Y. M., et al. (2019).
Transplantation 103(6): 1206-1215.
This systematic review aimed to explore the benefits and harms of interventions to prevent non-melanoma skin cancer in solid organ transplant recipients.
The MEDLINE, Embase, and the Cochrane CENTRAL register was searched for randomized controlled trials (RCTs) evaluating interventions to prevent nonmelanoma skin cancers in solid organ transplantation.
93 trials were identified and included in this review, including 20012 solid organ patients.
The primary efficacy outcome was skin cancer and the primary safety outcome was intervention-specific adverse events. Secondary outcomes included keratotic skin lesions, graft function, acute rejection, graft loss, all-cause mortality, cardiovascular events or mortality, infection, nonskin cancer and life participation.
Median: 24 months
This thorough systematic review evaluated interventions to prevent non-melanoma skin cancer in solid organ transplant patients. A comprehensive bibliographic search including hand-searching was conducted which identified 91 randomised controlled trials and one quasi-randomised controlled trial for inclusion, reporting on 20,012 patients. Risk of bias was assessed and GRADE was used to evaluate the certainty of the evidence. Study selection, data extraction and risk of bias assessment were done by two independent reviewers. Treatment effects were calculated using random effects meta-analysis and subgroup analyses to explore sources of heterogeneity were defined a priori. Risk of bias across different domains was high or unclear in most trials. Most of the evidence was of low or very low certainty. Two analyses provided moderate certainty evidence: mTOR inhibitors probably reduced the risk of skin cancer compared to calcineurin inhibitors (12 trials 2225 patients, RR 0.62, 95% confidence interval 0.45-0.85) and the effect of imiquimod was uncertain when compared to placebo (2 trials, 63 patients). Overall the evidence is limited, also due to the low incidence of skin cancers in the trials.