Transplants & Cancer Risk: Can Sirolimus Help?

Another complication I’ve been seeing frequently occur in some transplant recipients is the increased risk of Cancer (especially skin cancer).

I know I am at higher risk for skin cancer because of family history & having a fair complexion.  The immunosuppression after transplant is only going to increase the predisposition, so I am educating myself & will continue to on what to look for. I am not going to walk around in paranoia about it. Nor will it scare me off of transplant.

I’m talking about this today because I know some people don’t realize that once someone has a transplant of any organ they are making some other health trade-offs. They are putting themselves at risk for other potential problems with what they gain. Overall, they do tend to gain more, for sure, but sometimes it’s not without cost or risk.

It’s quite obvious this can be attributed to immunosuppression in general in both cancer but also in transplant.

Lowering these risks is easier said than done, because without proper immunosuppression there is an increased risk of organ rejection.  This can be just as life-threatening a complication as an increased risk or occurrence of cancer (which is harder to fight properly when the immune system is suppressed).

I’m sure I will also be required to meet with a dermatologist at least once a year post transplant to specifically to look for any trouble spots to help head this off.

Right now, the use of sirolimus (the generic version of the drug Rapamune, which I’ve been taking since 2009) after lung transplant is still controversial in some cases & some centers. I am seeing that could change soon due to some recent news. In some cases, even before this news was starting to become more widely reported, it already had.

Obviously, since the drug impacts the ability to heal & is black-boxed for lung transplants, most of us who take the drug (either brand or generic) prior to transplant have to come off of it before our transplant can happen.

Since no one knows when that call comes in (the case of a lung transplant), they have to pull someone off the medicine at least a few weeks prior to that time.

It is then a judgement call by the transplant team as to when & if someone is put back on the drug after transplant.  Sometimes women with LAM have been put back on for medical reasons.  Sometimes it is completely discontinued.

I wouldn’t be upset if I were one of those cases that restarted the drug after transplant as long as it didn’t interact with my post transplant cocktail.

I say that because my TSC kidney issues resolved while I was receiving this drug. I also worry about what will happen to my kidneys during this time (not only from transplant & medications), but if those TSC complications will start up in the absence of sirolimus. I don’t go around worrying about it too much, but it’s a concern I have shared with my doctors.

I found this news article (that backs up the other news articles I found & linked to). All of this recent press does make me worry less about both situations if my doctors do put me back on the drug.

It shows promise that is not only safe to use post transplant but that it has the potential to keep my TSC complications at bay as well as lowering my cancer risk.

The most common way to address skin cancer in the transplant community is Mohs surgery.  I know some patients do well with this procedure, while others have problems.

Any surgical procedure post transplant is of concern. It does have the potential to be more complex & have increased risk associated with it.  If there is a way for some transplantees to be able to avoid Mohs surgery — or even just have less of them (at the very least) — that is a definite plus & welcome news.

 

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