Skin Health Institute, Carlton, Melbourne, Victoria, Australia.
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
Australas J Dermatol. 2022 May;63(2):e121-e126. doi: 10.1111/ajd.13821. Epub 2022 Mar 25.
Solid organ transplant recipients (SOTR) are at high risk of keratinocyte carcinoma (KC). Long-term evidence for acitretin as chemoprophylaxis in this population is lacking.
To determine the benefit of long-term acitretin for KC chemoprevention in SOTR.
A retrospective cohort study of SOTR treated with acitretin at an Australian transplant dermatology clinic was performed. General estimating equations were used to evaluate change in rates of histologically confirmed KC in the 6-12 months prior to acitretin and following a minimum 6 months of treatment. A control group of patients within the same service was included, comprising SOTR who were not treated with acitretin.
Twenty-two patients received acitretin treatment for at least 6 months, eighteen for at least 5 years and four for at least 9 years. The median KC rate pretreatment was 3.31 per year (IQR 1.93, 5.40). There was a significant reduction in the rate of KC in the first year of acitretin treatment (IRR 0.41, 95% CI 0.22, 0.76, P = 0.005), and this effect was observed for 5 years (IRR at 5 years 0.34, 95% CI 0.17, 0.67, P = 0.002). The control group had no statistically significant change in KC rate over time in the study.
Acitretin appears to be well-tolerated and effective in reducing KC in SOTR for at least 5 years. Study limitations include its retrospective nature, small sample size and lack of blinding.
实体器官移植受者（SOTR）患角质细胞癌（KC）的风险很高。缺乏长期使用阿维 A酯作为该人群化学预防的证据。
确定长期使用阿维 A酯预防 SOTR 角质细胞癌的益处。
对在澳大利亚移植皮肤科诊所接受阿维 A酯治疗的 SOTR 进行回顾性队列研究。使用广义估计方程评估在开始阿维 A酯治疗前的 6-12 个月和至少 6 个月治疗后的组织学证实的 KC 发生率变化。还纳入了同一服务中的未接受阿维 A酯治疗的患者作为对照组。
22 例患者接受了至少 6 个月的阿维 A酯治疗，18 例至少 5 年，4 例至少 9 年。治疗前 KC 发生率中位数为每年 3.31（IQR 1.93，5.40）。阿维 A酯治疗的第一年 KC 发生率显著降低（IRR 0.41，95%CI 0.22，0.76，P=0.005），并且这种效果持续了 5 年（IRR 在第 5 年为 0.34，95%CI 0.17，0.67，P=0.002）。在研究期间，对照组 KC 发生率没有统计学意义的变化。
阿维 A酯似乎耐受性良好，在 SOTR 中至少 5 年内有效降低 KC 发生率。研究的局限性包括其回顾性、样本量小和缺乏盲法。
