Research Awards Recipients

As patients live longer after receiving organ transplants, there is a need to better prevent the long-term effects of anti-rejection drugs, which are used to prevent organ rejection. In particular, long-term use of these drugs increases the risk of skin cancer. Skin cancer is now a leading cause of illness and disfigurement after kidney transplantation. Given the increased risk and burden of skin cancer in transplant recipients, prevention is critical. Nicotinamide is a form of vitamin B3 that has been shown to protect against skin cancer in the general population. However, it is unclear whether nicotinamide is safe and effective among immune-suppressed transplant recipients.

Methods
We will conduct a preliminary study to evaluate the use of oral nicotinamide (500 mg twice daily) to prevent skin cancer in 120 high-risk adult kidney transplant patients who have previously had at least one skin cancer. Patients will receive nicotinamide or sham tablets for 12-16 months. Our main objective is to determine the feasibility of conducting a larger, definitive trial that will involve more patients and longer follow-up. We will recruit patients from the University Health Network's Multi-Organ Transplant program and St Michael’s Hospital kidney transplant program, which are two of the largest transplant centres in Canada.

Relevance
Kidney transplants are a life-altering treatment for people with severe kidney disease. Given the scarcity of kidney donors and the risks involved with transplantation, it is important that everything possible is done to maintain long-term health and quality of life for these patients. This study will provide useful information about the safety and effectiveness of nicotinamide to prevent skin cancer in kidney transplant patients in Canada. Nicotinamide is readily available and evidence of its safety and effectiveness could be immediately translated into clinical practice. Prevention could help to avoid premature death and suffering from aggressive skin cancer, ultimately improving the lives of kidney transplant patients.

Biography
Dr. Chan is a clinical epidemiologist and Mohs skin cancer surgeon at Women’s College Hospital in Toronto, Canada. He is the Phelan Scientist at Women’s College Research Institute, Associate Professor of Medicine at University of Toronto, and Director of Transplant Dermatology at University Health Network. After obtaining his doctorate as a Rhodes Scholar at University of Oxford, Dr. Chan served as Special Advisor to the Canadian Institutes of Health Research and helped coordinate the World Health Organization’s International Clinical Trials Registry Platform. His research interests include the epidemiology and management of high-risk skin cancer in solid organ transplant recipients, as well as addressing issues of transparency and biases in clinical trials. He currently chairs the international SPIRIT initiative to improve the quality of clinical trial protocols.