Perera G K, Child F J, Heaton N, O'Grady J, Higgins E M
Department of Dermatology, King's College Hospital, Denmark Hill, Camberwell, London SE5 9RS, UK.
Br J Dermatol. 2006 May;154(5):868-72. doi: 10.1111/j.1365-2133.2006.07154.x.
The surgical advances made in the area of organ transplantation along with the use of more efficacious immunosuppression have meant an increase in patient survival. This longer-living transplant population has started to exhibit cutaneous problems, some of which lead to an increased mortality while others lead to a decline in the quality of life.
The primary objective was to determine the different types of cutaneous lesions encountered in the adult liver transplant population. Secondary objectives were to determine the impact, if any, of the duration of transplant, the type of immunosuppression involved and the degree of sun exposure and skin phototype, on the skin cancers encountered in this transplanted population.
Two dermatologists examined 100 consecutive liver transplant recipients (LTRs) attending the transplant outpatient department. Skin examination included the face and whole body and lesions found were categorized into the following groups: cutaneous malignancies, squamoproliferative lesions, cutaneous infections and others that did not fall into any of these categories.
The reasons for organ transplantation were numerous. The mean age at transplantation was 42.5 years. The average time since transplantation was 5.5 (range 0.75-16 years). Four patients developed skin cancers; among them there were a total of seven skin cancers (one squamous cell carcinoma, six basal cell carcinomas). Fungal infections accounted for 19% of all cutaneous infections seen, viral infections 2% and bacterial infections 5%. Triple-drug immunosuppressive therapy (ciclosporin A, azathioprine and prednisolone) was used in 35% of LTR patients, while dual therapy (tacrolimus and prednisolone) was used in 48% and monotherapy (tacrolimus) was used in 17% of LTRs.
Immunosuppressive therapy is believed to be one of the most important risk factors in the development of skin cancer in solid organ transplant recipients. The relatively low prevalence of skin cancer in our liver transplant population may in part be explained by the relatively high percentage of recipients on dual and monotherapy (48% and 17% respectively), and the shorter duration of therapy. Our study suggests that although LTRs are at higher risk of developing nonmelanoma skin cancer than the general population, the risk is comparable with other solid organ transplant recipients.
器官移植领域的手术进展以及更有效的免疫抑制药物的使用意味着患者生存率有所提高。这些寿命延长的移植受者群体开始出现皮肤问题，其中一些导致死亡率上升，而另一些则导致生活质量下降。
主要目的是确定成年肝移植受者中遇到的不同类型的皮肤病变。次要目的是确定移植持续时间、所涉及的免疫抑制类型、阳光暴露程度和皮肤光类型对该移植人群中遇到的皮肤癌的影响（如果有的话）。
两位皮肤科医生检查了连续100名到移植门诊就诊的肝移植受者（LTR）。皮肤检查包括面部和全身，发现的病变分为以下几组：皮肤恶性肿瘤、鳞状上皮增生性病变、皮肤感染以及不属于上述任何一类的其他病变。
器官移植的原因多种多样。移植时的平均年龄为42.5岁。移植后的平均时间为5.5年（范围为0.75 - 16年）。4名患者发生了皮肤癌；其中共有7例皮肤癌（1例鳞状细胞癌，6例基底细胞癌）。真菌感染占所有所见皮肤感染的19%，病毒感染占2%，细菌感染占5%。35%的LTR患者使用三联免疫抑制疗法（环孢素A、硫唑嘌呤和泼尼松龙），48%的患者使用双联疗法（他克莫司和泼尼松龙），17%的LTR患者使用单一疗法（他克莫司）。
免疫抑制疗法被认为是实体器官移植受者发生皮肤癌的最重要危险因素之一。我们肝移植人群中皮肤癌的相对低患病率部分可能是由于接受双联和单一疗法的受者比例相对较高（分别为48%和17%）以及治疗持续时间较短。我们的研究表明，虽然LTR发生非黑色素瘤皮肤癌的风险高于一般人群，但与其他实体器官移植受者相当。
