Fernandes Sónia, Carrelha Ana Sofia, Marques Pinto Gabriela, Nolasco Fernando, Barroso Eduardo, Cardoso Jorge
Serviço de Dermatologia e Venereologia. Hospital Curry Cabral. Lisboa. Portugal.
Acta Med Port. 2013 Sep-Oct;26(5):555-63. Epub 2013 Oct 31.
Several skin disorders, immunosuppression-induced, have been described in transplant recipients. The aim of our study is to characterize the clinical spectrum of skin disorders and to compare the findings in liver and kidney transplant recipients.
A retrospective descriptive study was conducted. Data were collected from the medical records of all liver and kidney transplant recipients from 2000 - 2010 who had been referred to our Dermato-Venereology Department.
Three hundred nineteen transplant recipients (23.5%) have been seen, resulting in 410 diagnoses (230 in the subpopulation of liver transplant recipients and 180 in the subpopulation of kidney transplant recipients) grouped into 4 categories: 1) cutaneous infections; 2) skin cancer or premalignant skin lesions; 3) cutaneous side-effects; 4) non-iatrogenic skin disorders. Cutaneous infections were the most common presentations (42.2%), on average 32.7 months after transplantation. The latter group included 20.5% of fungal, 12.7% viral and 8.5% bacterial infections. Skin cancer and premalignant skin lesions made up 11.7% of all diagnoses, over a mean of 44.8 months post transplant and occurring primarily in kidney transplant recipients (20.6% vs 4.8% in liver transplantation patients; P < 0.001). The kidney transplant population had a squamous cell carcinoma (SCC) to basal cell carcinoma (BCC) ratio of 1.3:1 with SCC predominance, and the liver transplant population had a BCC:SCC ratio of 3.5:1. We also identified 10.5% of cutaneous side-effects and 35.6% of non-iatrogenic skin disorders.
Although neoplastic pathology is more frequently mentioned in the literature, cutaneous infections were the most common diagnoses in our study. The significant differences between the two subpopulations studied may be related to higher immunosuppression after kidney transplantation.
The high number of skin disorders reported in these patients makes it essential for Dermato-Venereology to be included within the multidisciplinary post-transplant care provided.
移植受者中已出现多种免疫抑制诱导的皮肤疾病。我们研究的目的是描述皮肤疾病的临床谱，并比较肝移植和肾移植受者的研究结果。
进行了一项回顾性描述性研究。数据收集自2000年至2010年间转诊至我院皮肤性病科的所有肝移植和肾移植受者的病历。
共诊治了319例移植受者（占23.5%），得出410例诊断结果（肝移植受者亚组中有230例，肾移植受者亚组中有180例），分为4类：1）皮肤感染；2）皮肤癌或癌前皮肤病变；3）皮肤副作用；4）非医源性皮肤疾病。皮肤感染是最常见的表现（占42.2%），平均出现在移植后32.7个月。后一组包括20.5%的真菌感染、12.7%的病毒感染和8.5%的细菌感染。皮肤癌和癌前皮肤病变占所有诊断的11.7%，平均出现在移植后44.8个月，主要发生在肾移植受者中（肾移植患者为20.6%，肝移植患者为4.8%；P<0.001）。肾移植人群中鳞状细胞癌（SCC）与基底细胞癌（BCC）的比例为1.3:1，以SCC为主，而肝移植人群中BCC:SCC的比例为3.5:1。我们还确定了10.5%的皮肤副作用和35.6%的非医源性皮肤疾病。
尽管文献中更频繁提及肿瘤病理学，但在我们的研究中皮肤感染是最常见的诊断。所研究的两个亚组之间的显著差异可能与肾移植后更高的免疫抑制有关。
这些患者中报告的皮肤疾病数量众多，因此皮肤性病科必须纳入移植后多学科护理之中。
