Post-Transplant SCC — ESENeph MCQ

Correct answer: B — Multidisciplinary review of immunosuppression

Cancer should prompt specialist review of the net state of immunosuppression, tumour burden, rejection history and graft risk. Reduction or conversion from a calcineurin inhibitor to an mTOR inhibitor may be appropriate in selected patients, particularly with recurrent skin cancer, but it is not an automatic response to every first lesion because mTOR conversion has tolerability, rejection and mortality trade-offs. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: KDIGO guideline for the care of kidney transplant recipients. https://kdigo.org/guidelines/transplant-recipient/