Molina B D, Leiro M G C, Pulpón L A, Mirabet S, Yañez J F, Bonet L A, Vilchez F G, Delgado J F, Manito N, Rábago G, Arizón J M, Romero N, Roig E, Blasco T, Pascual D, de la Fuente L, Muñiz J
Heart Transplant Unit, Hospital Universitario Central de Asturias, Oviedo, Spain.
Transplant Proc. 2010 Oct;42(8):3001-5. doi: 10.1016/j.transproceed.2010.08.003.
The incidence of skin cancer in heart transplant (HT) patients is higher than in the general population, reversing the proportion of cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) with a predominance of the former. The etiologic role of new immunosuppressants is not well known. We sought to ascertain the incidence of SCC and BCC in HT patients and the risk factors for its occurrence.
We report the incidence of all types of post-HT skin cancer, SCC, and BCC among adult HT patients in Spain (4089 subjects) as well as the influence of gender, age at heart transplant, immunosuppression, and sunlight exposure.
The incidence rates of SCC and BCC, per 1000 persons/year, were 8.5 and 5.2, respectively. Males had a higher risk of SCC but not BCC. Induction therapy increased the risk of SCC and BCC. The relative risk of mycophenolate mofetil (MMF) was 0.3 (0.2-0.6; P<.0005) and azathioprine (AZA) 1.8 (1.2-2.7; P<.0032) for SCC, whereas tacrolimus and cyclosporine showed no difference. The relative risk of BCC was not affected by any immunosuppressant.
Age at transplantation>45 years, induction therapy use, and high sunshine zone were risk factors for both SCC and BCC. Different immunosuppressive agents have different risks of nonmelanoma skin cancer, as AZA increases the risk of SCC and MMF is a protective factor. The relative risk of BCC was not affected by any immunosuppressor.
心脏移植（HT）患者皮肤癌的发病率高于普通人群，皮肤鳞状细胞癌（SCC）和基底细胞癌（BCC）的比例发生逆转，前者占主导地位。新型免疫抑制剂的病因学作用尚不清楚。我们试图确定HT患者中SCC和BCC的发病率及其发生的危险因素。
我们报告了西班牙成年HT患者（4089名受试者）中所有类型的HT后皮肤癌、SCC和BCC的发病率，以及性别、心脏移植时的年龄、免疫抑制和阳光照射的影响。
SCC和BCC的发病率分别为每1000人/年8.5例和5.2例。男性患SCC的风险较高，但患BCC的风险不高。诱导治疗增加了SCC和BCC的风险。对于SCC，霉酚酸酯（MMF）的相对风险为0.3（0.2 - 0.6；P <.0005），硫唑嘌呤（AZA）为1.8（1.2 - 2.7；P <.0032），而他克莫司和环孢素无差异。BCC的相对风险不受任何免疫抑制剂的影响。
移植时年龄>45岁、使用诱导治疗和高阳光照射区是SCC和BCC的危险因素。不同的免疫抑制剂对非黑色素瘤皮肤癌有不同的风险，如AZA增加SCC的风险，而MMF是一个保护因素。BCC的相对风险不受任何免疫抑制剂的影响。
