Relative carcinogenicity of tacrolimus vs mycophenolate after solid organ transplantation and its implications for liver transplant care

ARTICLE HIGHLIGHTS

Research background

Many liver transplant (LT) recipients are able to be maintained on long-term immunosuppressive monotherapy, most commonly with either tacrolimus or mycophenolate. In experimental studies, tacrolimus is associated with increased carcinogenicity, whereas mycophenolic acid (MPA) may have anti-neoplastic properties. However, there is minimal clinical data comparing the relative carcinogenicity of tacrolimus and MPA in LT or other solid organ transplant recipients.

Research motivation

Post-transplant malignancy (PTM) is a leading cause of late mortality in LT recipients. Thus, a clinically relevant difference in the carcinogenic risk profile between tacrolimus and MPA will affect the choice of immunosuppressive agent used as maintenance monotherapy in LT patients.

Research objectives

To determine the relative carcinogenicity of tacrolimus and MPA in solid organ transplantation.

Research methods

A systematic review was conducted using PRISMA guidelines with relevant articles published between 1^st January 2002 to 11^th August 2022 retrieved from MEDLINE and Embase databases for review.

Research results

A total of 6 studies were included in this systematic review, which did not demonstrate a clear difference between tacrolimus and MPA in the development of de novo PTM following solid organ transplantation.

Research conclusions

The relative carcinogenicity of tacrolimus and MPA, and its clinical relevance in solid organ transplantation, remains unclear.

Research perspectives

This review highlights the need for further large, population-based prospective studies to further assess the carcinogenic profiles of tacrolimus and MPA, to assist physicians in the choice of immunosuppressive agent to use as maintenance monotherapy in LT patients.