Dermatology Unit, University and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Indian J Med Res. 2013 Jun;137(6):1188-92.
BACKGROUND & OBJECTIVES: Kidney transplantation is the best option for patients with end-stage renal disease (ESRD) failure. Prolonged use of immunosuppressive drugs often causes opportunistic infections and malignancies of skin and mucosae, but due to lack of a careful dermatological screening in several transplantation centers the diagnosis and the treatment of dermatological lesions in kidney transplant patients are underestimated. In addition after the introduction of interleukin (IL)-2 -receptor antagonists (basiliximab/daclizumab), mTOR inhibitors and mycophenolate mofetil (MMF)/mycophenolic acid (MPA) in new immunosuppressive protocols only a few studies have analyzed the skin and mucosal lesions in kidney transplant patients. This study was undertaken to evaluate the cutaneous and mucosal diseases after kidney transplantation, and to investigate the association between these and different immunosuppressive protocols and/or demographic features.
A retrospective analysis was done using medical records of kidney transplantation between 2000 and 2009 at the Transplant Unit of Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. The study included 183 patients (M 57.3%, F 42.7%) aged 51.5 ± 11.8 yr) with transplant age 52.3 ± 34.9 months. Induction therapy was basiliximab and steroids based; maintenance therapy included combination-regimes from cyclosporine, tacrolimus, steroids, mycophenolate mofetil (MM), mycophenolic acid (MPA), rapamycin, everolimus. Anti-rejection therapy was steroid and/or thymoglobulines based. Diagnosis of cutaneous disease was made through examination of skin, mucous membranes, nails and hair evaluation. Skin biopsies, specific cultures and serological tests were done when required.
Skin and mucosal diseases were reported in 173 (95.7%) of patients; 88 (50.81%) showed viral lesions; 92 (53.01%) immunosuppression-related lesions; 28 (16.39%) benign tumours; 26 (15.3%) precancers /neoplastic lesions; 24 (14.21%) mycosis; 16 (9.29%) cutaneous xerosis, 15 (8.74%) dermatitis, while absence of cutaneous disease was evident only in 8 (4.37%) cases. An association between drug side effects and anti-rejection treatment ( P ≤ 0.01) and/or calcineurin-inhibitors (CNI) exposure ( P ≤ 0.01) was found. Longer exposure to immunosuppressive drugs (>60 months) was associated with pre-malignancy and malignancy lesions.
INTERPRETATION & CONCLUSIONS: Cutaneous diseases are frequent in kidney transplanted patients. Continuous skin monitoring is necessary to make an early diagnosis and to start appropriate treatment.
对于终末期肾病（ESRD）衰竭的患者来说，肾移植是最佳选择。长期使用免疫抑制剂常常导致皮肤和黏膜的机会性感染和恶性肿瘤，但由于在一些移植中心缺乏仔细的皮肤科筛查，导致对肾移植患者的皮肤病变的诊断和治疗被低估。此外，在白细胞介素（IL）-2 受体拮抗剂（巴利昔单抗/达利珠单抗）、雷帕霉素（mTOR）抑制剂和霉酚酸酯（MPA）/霉酚酸（MPA）在新的免疫抑制方案引入后，只有少数研究分析了肾移植患者的皮肤和黏膜病变。本研究旨在评估肾移植后皮肤和黏膜疾病，并探讨这些疾病与不同免疫抑制方案和/或人口统计学特征之间的关系。
对意大利帕维亚圣马泰奥基金会综合临床医院移植科 2000 年至 2009 年间的肾移植患者的病历进行回顾性分析。该研究纳入了 183 名患者（M 57.3%，F 42.7%），年龄为 51.5±11.8 岁），移植年龄为 52.3±34.9 个月。诱导治疗采用巴利昔单抗和皮质类固醇；维持治疗包括环孢素、他克莫司、皮质类固醇、霉酚酸酯（MM）、霉酚酸（MPA）、雷帕霉素、依维莫司的联合方案。抗排斥治疗基于皮质类固醇和/或胸腺球蛋白。通过检查皮肤、黏膜、指甲和毛发评估来诊断皮肤疾病。必要时进行皮肤活检、特定培养和血清学检查。
173 例（95.7%）患者报告有皮肤和黏膜疾病；88 例（50.81%）表现为病毒性病变；92 例（53.01%）为免疫抑制相关病变；28 例（16.39%）为良性肿瘤；26 例（15.3%）为癌前病变/肿瘤病变；24 例（14.21%）为真菌感染；16 例（9.29%）为皮肤干燥症；15 例（8.74%）为皮炎；而仅有 8 例（4.37%）患者无皮肤疾病。药物副作用和抗排斥治疗（P≤0.01）以及/或钙调磷酸酶抑制剂（CNI）暴露（P≤0.01）与药物不良反应之间存在相关性。更长时间的免疫抑制药物暴露（>60 个月）与癌前和恶性病变有关。
皮肤疾病在肾移植患者中很常见。需要持续监测皮肤，以便及早诊断和开始适当治疗。
