Ducroux Emilie, Martin Clemmie, Bouwes Bavinck Jan Nico, Decullier Evelyne, Brocard Anabelle, Westhuis-van Elsäcker Marlies E, Lebbé Céleste, Francès Camille, Morelon Emmanuel, Legendre Christophe, Joly Pascal, Kanitakis Jean, Jullien Denis, Euvrard Sylvie, Dantal Jacques
1 Department of Dermatology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France. 2 Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands. 3 Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France. 4 Université de Lyon, Laboratoire Santé Individu Société, Lyon, France. 5 Department of Dermatology, Nantes University Medical Center, Nantes, France. 6 Department of Dermatology, Saint Louis Hospital, APHP, University Paris VII, Paris, France. 7 Department of Dermatology, Tenon Hospital, APHP, University Paris VI, Paris, France. 8 Department of Transplantation and Nephrology, Edouard Herriot Hospital, Université de Lyon, Lyon, France. 9 Department of Nephrology-Transplantation, Necker Hospital, APHP, Paris, France. 10 Department of Dermatology, Charles-Nicolle University Medical Center, Rouen, France. 11 Department of Renal Medicine and Transplantation, Nantes University Medical Center, Nantes, France.
Transplantation. 2017 Apr;101(4):e133-e141. doi: 10.1097/TP.0000000000001644.
The course of skin cancer after retransplantation in organ-transplant recipients who have already developed posttransplant skin cancer has not been assessed.
This retrospective multicentric study included 53 patients with a history of cutaneous squamous cell carcinoma (SCC) after a first kidney transplantation who received a second kidney transplantation. The primary endpoint was the occurrence of aggressive cutaneous SCC after the second transplantation. Secondary endpoints included the course of skin cancers over 3 periods (first transplantation, return to dialysis, second transplantation), the time to occurrence, and risk factors for aggressive SCC after retransplantation.
The first SCC developed in 47 patients with a functional graft and in 6 after return to dialysis. After the first transplantation, 17 (33.3%) patients developed SCC in dialysis and 39 (73.6%) after the second transplantation, respectively. Twenty aggressive SCC developed over the study period. They occurred in 14 (26.4%) patients after retransplantation vs 5 (9.4%) after the first transplantation with a median delay of 50 months and were responsible for 5 deaths. Fair skin type, multiple tumors before retransplantation, treatment with azathioprine, T cell-depleting antibodies, and delayed revision of immunosuppression were associated with an increased risk of aggressive cutaneous SCC after retransplantation.
Candidates to retransplantation with a history of posttransplant SCC have a high risk of aggressive SCC. Our data suggest that the risk could be reduced by a tailored immunosuppression. A wait period may be required depending on the clinicopathological characteristics of the previous SCC and discussed on an individual patient basis.
对于已发生移植后皮肤癌的器官移植受者，再次移植后皮肤癌的病程尚未得到评估。
这项回顾性多中心研究纳入了53例首次肾移植后发生皮肤鳞状细胞癌（SCC）且接受了第二次肾移植的患者。主要终点是第二次移植后侵袭性皮肤SCC的发生情况。次要终点包括三个时期（首次移植、恢复透析、第二次移植）皮肤癌的病程、发生时间以及再次移植后侵袭性SCC的危险因素。
47例移植肾功能良好的患者以及6例恢复透析后的患者出现了首例SCC。首次移植后，分别有17例（33.3%）患者在透析期间发生SCC，39例（73.6%）患者在第二次移植后发生SCC。在研究期间共发生了20例侵袭性SCC。它们发生在14例（26.4%）再次移植后的患者中，而首次移植后为5例（9.4%），中位延迟时间为50个月，导致5例死亡。皮肤白皙类型、再次移植前有多个肿瘤、使用硫唑嘌呤、T细胞清除抗体治疗以及免疫抑制调整延迟与再次移植后侵袭性皮肤SCC风险增加相关。
有移植后SCC病史的再次移植候选者发生侵袭性SCC的风险很高。我们的数据表明，通过个体化免疫抑制可能降低风险。可能需要根据先前SCC的临床病理特征设定等待期，并对每个患者进行个体化讨论。
