Skin cancer in heart transplant recipients

España, A.; Redondo, Pedro; Teijeira-Fernández, Elvis; Zabala, Martín; Herreros, Jesús; Llorens, R.; Quintanilla, E.

doi:10.1016/0190-9622(95)90069-1

Cited by 107 publications

(59 citation statements)

References 38 publications

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“…9 Exposure to the sun is intense in Spain, and a high incidence of skin cancer is reported in Spanish heart transplant recipients. 12 Our cumulative incidence at 8 years post-OLT (17%) is less than that reported in renal or heart transplant recipients in Australia (Ͼ30%), but greater than that described in Dutch renal or liver transplant recipients (7% to 13%), 8,13,14 which may reflect differences in latitude and sun exposure of these countries and perhaps differences in immunosuppressive schedules. However, the posttransplantation tumor rate has been reported to be similar for three-or fourdrug regimens, 15,16 suggesting that geographic factors, rather than the immunosuppressive schedule, are the main determinants of our high rate of de novo skin cancer.…”

Section: Discussioncontrasting

confidence: 38%

Risk factors for development of de novo neoplasia after liver transplantation

Xiol

Guardiola²,

Menéndez

et al. 2001

Liver Transplantation

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Liver transplant recipients are at greater risk for de novo neoplasia, especially lymphoma and nonmelanoma skin cancer; however, risk factors for this complication have not been well studied. Clinical and pathological records of 137 consecutive liver transplant recipients who had survived for at least 1 year were reviewed to register de novo neoplasia. Ten variables were analyzed for their association with the development of de novo malignancies by means of a log-rank test and stepwise selection in a multivariate analysis using the Cox proportional hazard model. Thirty de novo neoplasias appeared in 22 of 137 transplant recipients between 12 and 104 months after orthotopic liver transplantation (OLT; median follow-up, 69 months): 14 patients had 21 skin cancers, 6 patients had solid-organ cancer, and 3 patients developed a lymphoproliferative disease. Probabilities of de novo neoplasia were 13% at 5 years post-OLT and 26% at 8 years post-OLT. The only associated risk factor for any neoplasia was age. Age and hepatocarcinoma were independent risk factors associated with skin cancer. That hepatocarcinoma in the explanted liver is an independent risk factor for skin cancer suggests there is individual susceptibility to both neoplasias. (Liver Transpl 2001;7:971-975.)

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Section: Discussioncontrasting

confidence: 38%

Risk factors for development of de novo neoplasia after liver transplantation

Xiol

Guardiola²,

Menéndez

et al. 2001

Liver Transplantation

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“…Different skin cancers were most common followed by lymphoma and lung cancer. Little is known of tumours in heart recipients with diabetes, however a large series of recipients without diabetes report similar data on malignancy [15,28,29,30].…”

Section: Discussionmentioning

confidence: 99%

The impact of diabetes mellitus at the time of heart transplantation on long-term survival

Czerny

Şahin

Fasching³

et al. 2002

Diabetologia

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Aims/hypothesis. To analyse the impact of diabetes mellitus (DM) at the time of heart transplantation on long-term survival and incidence of transplant coronary artery disease (TxCAD). Methods. We analysed 773 consecutive adult heart transplant recipients who underwent primary heart transplantation from May 1986 until December 2000. The cohort consisted of 140 patients with diabetes mellitus (with DM, men 82%) and 633 patients without (wo DM, men 84%) diabetes mellitus at the time of transplantation. The patients were documented as to survival and incidence of TxCAD. Results. Patients with diabetes mellitus were older compared to those without diabetes mellitus (with DM 54.9±6.8a vs wo DM 49.7±10.8a; p=0.0001), they had a higher incidence of ischaemic cardiomyopathy prior to transplantation (with DM 52% vs wo DM 30%; p=0.0001), but reduced long-term survival (10 year survival: with DM 40% vs wo DM 58%; logrank=0.025). Surprisingly, the incidence of transplant coronary artery disease (TxCAD) was comparable at 10 years (with DM 28% vs wo DM 22%; logrank=0.625). In multivariate Cox proportional hazard analysis, diabetes mellitus present at the time of heart transplantation (HR 1.594; 95%CI 1.009-2.518; p=0.045), but not age (HR 0.990; 95%CI 0.965-1.014; p=0.404) was an independent predictor affecting long-term survival. Conclusion/interpretation. The presence of diabetes mellitus at the time of heart transplantation adversely affects long-term patient survival, but does not predict the occurrence of transplant coronary artery disease. The definite mechanisms of adverse survival primarily seem to relate to generally impaired global organ function. Despite a less favourable long-term outcome, our data still justify heart transplantation in end-stage heart failure patients with diabetes mellitus.

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“…3 Similarly, a significant incidence of skin cancer has been documented in solid organ transplant recipients with a 20-fold increased risk for developing SCC in kidney and heart transplant recipients. 7 Skin tumors behave more aggressively in these patients than in immunocompetent individuals and have a higher risk of metastasis. 7 It was not until this year that chronic GVHD without treatment was shown to be linked with a higher risk of SCC of the skin and buccal cavity.…”

Section: Discussionmentioning

confidence: 99%

“…7 Skin tumors behave more aggressively in these patients than in immunocompetent individuals and have a higher risk of metastasis. 7 It was not until this year that chronic GVHD without treatment was shown to be linked with a higher risk of SCC of the skin and buccal cavity. 3 Irradiation and immunosuppressive drugs are used for conditioning and for prophylaxis/treatment of GVHD.…”

Section: Discussionmentioning

confidence: 99%

“…3 Consistent with this observation, an increased incidence of cancer was previously observed in dogs given TBI before transplant (no relationship with increasing dosage was indicated) compared to dogs not receiving TBI. 8 Azathioprine (AZA) and CsA have been reported to be associated with an increased risk for secondary neoplasms in solid organ transplant recipients 7 and, also, AZA appears to promote/facilitate secondary neoplasms when used as treatment for chronic GVHD. 9 In contrast to AZA, CsA is not mutagenic but rather impairs functional T cell-mediated tumor surveillance.…”

Section: Discussionmentioning

confidence: 99%

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Anaplastic squamous cell carcinoma (SCC) in a patient with chronic cutaneous graft-versus-host disease (GVHD)

Gmeinhart

Hinterberger

Greinix

et al. 1999

Bone Marrow Transplant

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Summary:We describe an allogeneic bone marrow (BM) recipient who developed aggressive, metastasizing squamous cell cancer (SCC) of the skin, and discuss possible risk factors in the development of this secondary solid tumor. The patient had been treated with cyclosporine (CsA), methyl-prednisolone and thalidomide for 3 years because of extensive de novo chronic cutaneous GVHD occurring 1 year after BMT. Ten years after BMT a locally invasive and metastasizing SCC occurred on the patient's neck, and diagnosis was confirmed by H&E histopathology and cytokeratin-immunohistochemistry. Analysis of genomic DNA did not reveal p53 mutations nor were HPV sequences detectable. Risk factors included conditioning for BMT with total body irradiation (TBI) and cyclophosphamide (Cy), immunosuppressive treatment for GVHD, and extensive exposure to UV radiation before and after BMT. Despite surgery and adjuvant chemotherapy with 5-fluorouracil (5-FU) the patient died 1 year after the diagnosis of SCC. Keywords: secondary malignancy; squamous cell carcinoma; GVHD; immunosuppression With numbers of BM transplants from related and unrelated donors increasing recently the frequency of secondary neoplasms which impair long-term outcome and survival of the BM recipients has also been increasing. The risk of developing secondary cancer after allogeneic BMT has been reported to be increased 6.69-to 11-fold over that of an age-matched population. 1,2 Whereas lymphoproliferative cancers, myelodysplastic syndrome, acute leukemia and non-Hodgkin's lymphoma predominate in the first years after BMT, solid cancers including neoplasms of the central nervous system, bone, inner organs, skin and mucosal sur- faces occur progressively 10-15 years thereafter. 1-3 The largest cohort study on nearly 20 000 allogeneic BM recipients showed the cumulative incidence for secondary solid tumors to be 6.7%. Case reportSCC was diagnosed in a previously healthy 26-year-old Caucasian male patient in January 1985 who subsequently received 8 units of packed red blood cells and 4 units of platelets. Five months later, after conditioning with 200 mg Cy/kg body weight (b.w.) over 4 days and TBI of 3 Gy, he received 2.7 ϫ 10 8 nucleated cells (NC)/kg b.w. from his HLA class I and II identical brother. Methotrexate (MTX) according to the Seattle protocol was used as GVHD prophylaxis. Neutrophil counts of more than 0.5 ϫ 10 9 /l and 1 ϫ 10 9 /l were reached on days ϩ35 and ϩ53, respectively, after BMT. Unsupported platelets Ͼ20 ϫ 10 9 /l, hematocrit Ͼ30% and reticulocytes Ͼ20 000/ml without the need for further transfusion were reached on days ϩ24 and ϩ12, respectively. Donor cell engraftment was documented by the presence of donor ABO blood group. Because of poor marrow function MTX was stopped on day ϩ39. The patient showed no signs of acute GVHD and was discharged on day ϩ49 post BMT.One year after BMT, he developed de novo onset chronic cutaneous GVHD with lichenoid lesions on the lips and oral mucosa. We initiated systemic immunosuppression with 1.5 mg prednisolo...

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Skin cancer in heart transplant recipients

Cited by 107 publications

References 38 publications

Risk factors for development of de novo neoplasia after liver transplantation

Risk factors for development of de novo neoplasia after liver transplantation

The impact of diabetes mellitus at the time of heart transplantation on long-term survival

Anaplastic squamous cell carcinoma (SCC) in a patient with chronic cutaneous graft-versus-host disease (GVHD)

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