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Impact of mTOR Inhibitors on Cancer Development in Kidney Transplantation Recipients: A Population-Based Study
1Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Background:
The mammalian target of rapamycin (mTOR) inhibitor is an immunosuppressive drug used in kidney transplantation. Whether the mTOR inhibitor is associated with reduced risk of cancer development and mortality after kidney transplantation is controversial.
Methods:
We conducted a nationwide population-based study. Patients who did not have malignancy history and received kidney transplantation between 2010 and 2013 were enrolled. Recipients who had mTOR inhibitors (n = 430) for more than 30 days comprised the study group; 1720 recipients who did not have mTOR inhibitors comprised the control group. The primary outcome is the development of cancer after kidney transplantation. These patients were followed until the first-time admission with diagnosis of cancer, death, or the end of 2014. A Cox proportional-hazard model was used to determine the risk of cancer development and all-cause mortality.
Results:
During the 35-month median duration of observation, there were 16 and 61 patients with cancer development in the study group and the control group, respectively. The cancer incidence was 12.8 and 12.4 per 1000 person-years. There were 10 and 135 mortality cases, with the incidence rate of 7.8 and 26.9 per 1000 person-years. After multivariable adjustment, the mTOR inhibitors users were not associated with reduced risk of new cancer development as compared with control (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.46-1.60; P = .63), nor risk of all-cause mortality (HR, 0.70; 95% CI, 0.33-1.46; P = .34).
Conclusions:
The use of mTOR inhibitors was not associated with a reduction in the risk of cancer development and all-cause mortality in kidney transplantation recipients.
Insights
Mammalian target of rapamycin (mTOR) inhibitors, used in kidney transplants, did not show a reduced risk of cancer or death in recipients. This study found no significant association between mTOR inhibitor use and lower cancer incidence or mortality rates.
Area of Science:
- Nephrology
- Immunosuppression
- Oncology
Background:
- Mammalian target of rapamycin (mTOR) inhibitors are immunosuppressive agents commonly used in kidney transplantation.
- The potential benefit of mTOR inhibitors in reducing cancer development and mortality post-transplant remains a subject of debate.
Purpose of the Study:
- To investigate the association between mTOR inhibitor use and the risk of new cancer development after kidney transplantation.
- To evaluate the impact of mTOR inhibitors on all-cause mortality in kidney transplant recipients.
Main Methods:
- A nationwide, population-based cohort study was conducted, enrolling kidney transplant recipients between 2010 and 2013 without prior malignancy.
- Patients receiving mTOR inhibitors for over 30 days (n=430) were compared to a control group (n=1720) not on mTOR inhibitors.
- Cox proportional-hazard models were utilized to assess the risks of cancer development and mortality.
Main Results:
- Over a median follow-up of 35 months, cancer incidence was similar between the mTOR inhibitor group (12.8 per 1000 person-years) and the control group (12.4 per 1000 person-years).
- Mortality rates were 7.8 per 1000 person-years for mTOR inhibitor users versus 26.9 per 1000 person-years for controls.
- Multivariable analysis revealed no statistically significant association between mTOR inhibitor use and reduced risk of new cancer development (HR, 0.86; P=.63) or all-cause mortality (HR, 0.70; P=.34).
Conclusions:
- The use of mTOR inhibitors in kidney transplant recipients is not associated with a decreased risk of developing new cancers.
- mTOR inhibitor therapy following kidney transplantation did not demonstrate a significant reduction in the risk of all-cause mortality.
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