Department of Dermatology, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA.
School of Medicine, University of Southern California, Los Angeles, CA, USA.
Clin Drug Investig. 2019 Feb;39(2):197-203. doi: 10.1007/s40261-018-0732-3.
Organ transplantation is a significant risk factor for the development of skin cancer. The impact of skin type, immunosuppressive regimens, and photosensitizing agents requires further study.
The objective of this study was to compare skin cancer development between Caucasian and non-Caucasian transplant recipients at the University of Southern California.
We performed a retrospective chart review of lung and liver transplantations to determine the incidence of post-transplant skin cancer. Participants included patients who underwent lung or liver transplantation between 2005 and 2013 at our institution. Patients included in the study were limited to those who survived through the study observation period.
We analyzed 475 patients who underwent transplantation, including 370 liver transplant recipients and 105 lung transplant recipients. Among these, 46.3% identified as Caucasian, while 53.7% were non-Caucasian. Over a mean follow-up of 7.9 years, 11.8% of Caucasian patients developed at least one skin cancer, compared with 2.7% of non-Caucasians (p < 0.001). However, irrespective of race, skin cancer development was significantly greater in lung compared with liver transplant recipients (20.0% vs. 3.2%, p < 0.001). The standard immunosuppressive and prophylactic regimens were mycophenolate mofetil and tacrolimus based for both transplants. Mycophenolate mofetil was maintained throughout the course in lung transplant patients, whereas this agent was reduced and terminated when possible in liver transplant recipients. In addition, during the years examined, voriconazole, a known photosensitizing agent, was used in lung transplant recipients to prevent aspergillosis.
Fair skin type increases post-transplant skin cancer development, irrespective of the immunosuppressive regimen. A higher risk of skin cancer is associated with different regimens; in particular photosensitizing agents may increase risk in transplant recipients.
器官移植是皮肤癌发展的一个重要危险因素。皮肤类型、免疫抑制方案和光敏剂的影响需要进一步研究。
本研究旨在比较南加州大学的白种人和非白种人器官移植受者皮肤癌的发病情况。
我们对肺和肝移植患者进行了回顾性图表审查，以确定移植后皮肤癌的发病率。参与者包括 2005 年至 2013 年期间在本机构接受肺或肝移植的患者。研究纳入的患者仅限于在研究观察期内存活的患者。
我们分析了 475 名接受移植的患者，包括 370 例肝移植受者和 105 例肺移植受者。其中，46.3%为白种人，53.7%为非白种人。在平均 7.9 年的随访中，11.8%的白种人至少患有一种皮肤癌，而非白种人则为 2.7%（p<0.001）。然而，无论种族如何，肺移植受者的皮肤癌发病率明显高于肝移植受者（20.0%比 3.2%，p<0.001）。两种移植均采用霉酚酸酯和他克莫司作为标准免疫抑制和预防方案。肺移植患者在整个疗程中均使用霉酚酸酯，而肝移植患者则尽可能减少并停用该药物。此外，在研究期间，肺移植患者使用伏立康唑（一种已知的光敏剂）预防曲霉病。
皮肤白皙的人种增加了移植后的皮肤癌发病风险，而与免疫抑制方案无关。不同的方案与更高的皮肤癌风险相关；特别是光敏剂可能会增加移植受者的风险。
