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Post-Transplant SCC — RACP Adult Medicine MCQ

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ModerateNephrologyPost-Transplant SCCRACP Adult Medicine

A 55-year-old renal transplant recipient (10 years post-transplant, on tacrolimus/mycophenolate/prednisolone) develops multiple keratotic skin lesions on sun-exposed areas. Biopsy confirms well-differentiated squamous cell carcinoma. He has had 8 SCCs excised in the past 3 years. What is the most appropriate immunosuppression modification?

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Correct answer: E — Switch to sirolimus-based immunosuppression

Multiple recurrent SCCs in transplant recipients should prompt consideration of switching calcineurin inhibitors (tacrolimus/ciclosporin) to mTOR inhibitors (sirolimus/everolimus). mTOR inhibitors have anti-tumour properties and reduce skin cancer incidence by ~50% in transplant recipients (CONVERT trial). The switch should be made in consultation with the transplant team. Sun protection and regular skin checks are essential.

Reference: TSANZ – 2024 – Post-Transplant Malignancy; KDIGO 2024