Miotto Isadora Zago, Festa Neto Cyro, de Oliveira Walmar Roncalli Pereira
Department of Dermatology, University of São Paulo Medical School, Av Dr Enéas de Carvalho Aguiar, 255, Zip Code, 05403-900, São Paulo, Brazil.
Transpl Immunol. 2023 Jun;78:101838. doi: 10.1016/j.trim.2023.101838. Epub 2023 Apr 19.
Solid organ transplant recipients (SOTRs) are susceptible to various dermatological complications caused by long-term immunosuppressive therapy. Of these complications, viral infections are noteworthy because of their high prevalence and the potential morbidity associated with viral carcinogenesis.
To evaluate the occurrence of cutaneous viral infections in SOTRs and their correlation with clinical features, transplant type, and the length and intensity of immunosuppressive therapy.
This retrospective cohort study included SOTRs followed up at the Department of Dermatology in a tertiary hospital. The outcomes analyzed were the occurrence of cutaneous viral infections, including human papillomavirus (HPV) infection, herpes simplex, herpes zoster, molluscum contagiosum, Merkel cell carcinoma, Kaposi's sarcoma, and cytomegalovirus, and the occurrence of HPV-related neoplasms. Clinical variables, such as length and intensity of immunosuppression, type of transplanted organ, and comorbidities, were analyzed as possible risk factors for cutaneous viral infections in SOTRs.
A total of 528 SOTRs were included in this study, among which 53.8% had one or more viral infections. Of these, 10% developed a virus-associated malignancy (HPV-associated carcinoma, Merkel cell carcinoma, or Kaposi's sarcoma). The higher risk of viral infections among SOTRs was associated with cyclosporine intake (1.40-fold higher risk) and younger age at transplantation. The use of an immunosuppressive regimen, including additional drugs, was associated with a higher risk of genital HPV infection (1.50-fold higher risk for each incremental drug).
The occurrence of cutaneous viral infections in SOTRs is directly associated with the duration and intensity of immunosuppressive therapy. Patients at higher risk were those taking drugs with a stronger impact on cellular immunity and/or those on an immunosuppressive regimen comprising various drugs.
实体器官移植受者（SOTRs）易患由长期免疫抑制治疗引起的各种皮肤并发症。在这些并发症中，病毒感染因其高患病率以及与病毒致癌相关的潜在发病率而值得关注。
评估SOTRs中皮肤病毒感染的发生率及其与临床特征、移植类型以及免疫抑制治疗的时长和强度的相关性。
这项回顾性队列研究纳入了在一家三级医院皮肤科接受随访的SOTRs。分析的结果包括皮肤病毒感染的发生情况，包括人乳头瘤病毒（HPV）感染、单纯疱疹、带状疱疹、传染性软疣、默克尔细胞癌、卡波西肉瘤和巨细胞病毒，以及HPV相关肿瘤的发生情况。将免疫抑制的时长和强度、移植器官类型以及合并症等临床变量作为SOTRs中皮肤病毒感染的可能危险因素进行分析。
本研究共纳入528例SOTRs，其中53.8%发生了一种或多种病毒感染。其中，10%发生了与病毒相关的恶性肿瘤（HPV相关癌、默克尔细胞癌或卡波西肉瘤）。SOTRs中病毒感染风险较高与服用环孢素（风险高1.40倍）以及移植时年龄较小有关。使用包括其他药物在内的免疫抑制方案与生殖器HPV感染风险较高有关（每增加一种药物，风险高1.50倍）。
SOTRs中皮肤病毒感染的发生与免疫抑制治疗的持续时间和强度直接相关。风险较高的患者是那些服用对细胞免疫影响较强药物的患者和/或那些采用包含多种药物的免疫抑制方案的患者。
