Immunosuppressive therapy in the posttransplant period and skin cancer

Krásová, Martina; Sečníková, Zuzana; Göpfertová, Dana; Hercogová, Jana; Viklický, Ondřej; Jůzlová, Kateřina; Jiráková, Anna; Šmerhovský, Zdeněk

doi:10.1111/dth.12379

Cited by 10 publications

(12 citation statements)

References 11 publications

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“…The use of ciclosporin A has been reported as ineffective in two patients . Given the risk of skin cancer associated with both NS and ciclosporin A, we do not recommend using it (LoE 3, GoR D). Systemic immunoglobulins have been reported as safe and effective in five patients, but there is limited evidence to recommend them for long‐term treatment (LoE 3, GoR D).…”

Section: Particularities Of Congenital Ichthyosismentioning

confidence: 99%

Management of congenital ichthyoses: European guidelines of care, part two

et al. 2018

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These guidelines for the management of congenital ichthyoses have been developed by a multidisciplinary group of European experts following a systematic review of the current literature, an expert conference held in Toulouse in 2016, and a consensus on the discussions. These guidelines summarize evidence and expert-based recommendations and intend to help clinicians with the management of these rare and often complex diseases. These guidelines comprise two sections. This is part two, covering the management of complications and the particularities of some forms of congenital ichthyosis.

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Section: Particularities Of Congenital Ichthyosismentioning

confidence: 99%

Management of congenital ichthyoses: European guidelines of care, part two

et al. 2018

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“…Although skin cancers are known to be associated with immunosuppressive therapy, there are no conclusive data on the extent of the risk associated with each immunosuppressive drug. Several studies on heart, liver, and kidney transplant patients have shown a higher risk of skin cancers when calcineurin inhibitors are used 35‐37 . As far as antimetabolites are concerned, azathioprine has frequently been associated with a higher risk of skin cancers while mycophenolate mofetil seem to play a more controversial role 38‐40 .…”

Section: Discussionmentioning

confidence: 99%

“…Several studies on heart, liver, and kidney transplant patients have shown a higher risk of skin cancers when calcineurin inhibitors are used. [35][36][37] As far as antimetabolites are concerned, azathioprine has frequently been associated with a higher risk of skin cancers while mycophenolate mofetil seem to play a more controversial role. [38][39][40] On the other end of the spectrum, mTOR inhibitors have been reported to lower the risk of skin cancers as opposed to other immunosuppressive agents.…”

Section: Discussionmentioning

confidence: 99%

Skin cancers in Italian lung transplant recipients: Incidence and risk factors analysis

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Biolo

et al. 2021

Dermatologic Therapy

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Only a few studies reported the incidence and risk factors of skin cancers in lung transplant recipients. The aim of this study was to determine the cumulative incidence of skin cancers in a cohort of patients undergoing lung transplantation and to define predictors of their development. About 247 consecutive patients receiving lung transplantation at the Thoracic Surgery Unit of University Hospital of Padova between May 1995 and October 2016 were studied. Cumulative incidence of skin cancers was estimated considering death as a competing event. The effect of potential predictors was evaluated with univariate and multivariable Cox models for competing risks. About 37 (15.0%) patients developed skin tumors. The cumulative incidence of any skin cancer was 14.2% at 5 years, 21.4% at 10 years, and 24.3% at 15 years posttransplantation. Age at transplantation, male gender, phototype II, and voriconazole use were independent risk factors for development of squamous cell carcinoma. Only male gender and phototype II were independent risk factors for development of basal cell carcinoma. Since lung transplant recipients have a greater risk of developing skin cancers, the management of these patients needs a multidisciplinary approach, in which dermatologists and transplant physicians have a primary role.

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“…54 Another retrospective study of 797 RTRs reported that the risk of NMSC was significantly higher in patients receiving ATG compared with anti-CD 25 monoclonal antibody [Standardized morbidity ratio (SMR) = 4.14; 95% CI = 2.05-7.56, p = .000 for ATG and SMR = 2.02; 95% CI = 0.46-6.48, p = .293 for anti- CD 25]. 56 Based on existing data, long-term immunosuppressive medications used in the maintenance phase is also likely to be oncogenic.…”

Section: Oncogenic Effects Of Immunosuppressantsmentioning

confidence: 99%

“…Although there is no adequate evidence to recommend a specific interval of full skin examination, post-transplant skin cancer surveillance guidelines in Europe and United States advise full skin examination of SOTRs every 6-12 months in a specialist clinic. [55][56][57] Harwood et al provided a sensitive, practical and targeted algorithmic approach to define individual risk and calculate appropriate skin cancer surveillance intervals for detection of NMSC in SOTRs. 10 The frequency of examination should depend on the individual risks as proposed in Table 3 to identify precursors of skin cancers and early detection of skin carcinoma.…”

Section: Skin Cancer Surveillance and Prevention Programmentioning

confidence: 99%

Reducingnon‐melanomaskin cancer risk in renal transplant recipients

et al. 2021

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With an increasing number of renal transplant recipients (RTRs) and improving patient survival, a higher incidence of non-melanoma skin cancer (NMSC) has been observed. NMSC in RTRs are often more numerous and biologically more aggressive than the general population, thus contributing towards an increase in morbidity and to a lesser degree, mortality. The resultant cumulative health and financial burden is a recognized concern. Proposed strategies in mitigating risks of developing NMSC and early therapeutic options thereof include tailored modification of immunosuppressants in conjunction with sun protection in all transplant patients. This review highlights the clinical and financial burden of transplant-associated skin cancers, carcinogenic mechanisms in association with immunosuppression, importance of skin cancer awareness campaign and integrated transplant skin clinic, and the potential role of chemoprotective agents. A scheme is proposed for primary and secondary prevention of NMSC based on the available evidence.

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Immunosuppressive therapy in the posttransplant period and skin cancer

Abstract: The preliminary results indicate that the risk of NMSC in RTRs is significantly higher than in the general population and thus emphasize the need to improve preventive strategies in the Czech transplant population.

Cited by 10 publications

References 11 publications

Management of congenital ichthyoses: European guidelines of care, part two

Management of congenital ichthyoses: European guidelines of care, part two

Skin cancers in Italian lung transplant recipients: Incidence and risk factors analysis

Reducingnon‐melanomaskin cancer risk in renal transplant recipients

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