TRIPLE THERAPY AND INCIDENCE OF DE-NOVO CANCER IN RENAL-TRANSPLANT RECIPIENTS

Some 27 (5.5 per cent) of 492 renal transplant recipients developed de novo cancer between January 1975 and December 1991. Patients administ ered triple therapy of prednisolone, cyclosporin A and azathioprine ha d a significantly higher incidence of cancer (seven of 40 patients; 17 .5 per cent) than those given prednisolone with cyclosporin (14 of 319 ; 4.4 per cent) and azathioprine with prednisolone (six of 133; 4.5 pe r cent) (P = 0.005). In a prospective study between January 1989 and D ecember 1992, 110 renal transplant patients were randomized into three immunosuppressive regimens at the time of transplantation. The incide nce of cancer in patients receiving low-dose cyclosporin, azathioprine and prednisolone was three of 45, in those given high-dose cyclospori n and prednisolone none of 23 and in those administered high-dose cycl osporin, nifedipine and prednisolone one of 29. The addition of azathi oprine to ongoing maintenance cyclosporin and prednisolone therapy is useful in a subgroup of patients with graft dysfunction, but there are possibly higher risks in the development of de novo carcinoma.