Hofbauer G
Dermatologische Klinik, Universitätsspital Zürich, Gloriastr. 31, 8091, Zürich, Schweiz.
Hautarzt. 2010 Mar;61(3):214-9. doi: 10.1007/s00105-009-1861-7.
Immunosuppressive therapy keeps rejection in check following solid organ transplantation. Drug reactions, inflammatory and infectious skin conditions frequently follow. Specific side effects can be avoided by switching individual agents. In addition to UV light, immunosuppressants are the most important driver for squamous cell carcinoma of the skin (SCC). Beyond immunosuppression, cyclosporine A promotes carcinogenesis by TGF beta and VEGF, while mTOR inhibitors are antiproliferative. Azathioprine photosensitizes to UVA and enables UVA to damage DNA directly. To fight skin cancer, global reduction of immunosuppression is the most effective measure. Switching calcineurin inhibitors to mTOR inhibitors is probably to be recommended, while omitting azathioprine may potentially be advisable in recurrent SCC.
免疫抑制疗法可在实体器官移植后控制排斥反应。药物反应、炎症性和感染性皮肤病经常随之而来。通过更换个别药物可避免特定的副作用。除紫外线外，免疫抑制剂是皮肤鳞状细胞癌（SCC）最重要的驱动因素。除免疫抑制作用外，环孢素A通过转化生长因子β和血管内皮生长因子促进致癌作用，而雷帕霉素靶蛋白（mTOR）抑制剂具有抗增殖作用。硫唑嘌呤对紫外线A有光敏作用，使紫外线A能直接损伤DNA。为对抗皮肤癌，全面降低免疫抑制是最有效的措施。可能建议将钙调神经磷酸酶抑制剂换成mTOR抑制剂，而在复发性皮肤鳞状细胞癌中，停用硫唑嘌呤可能是可取的。
