Subsequent nonmelanoma skin cancers and impact of immunosuppression in liver transplant recipients - 18/06/18
Abstract |
Background |
Nonmelanoma skin cancers (NMSCs) are the most frequent cancers in solid organ transplant recipients, with a high rate of subsequent tumors.
Objectives |
To describe subsequent NMSCs in a large cohort of liver transplant recipients (LTRs) with long follow-up and analyze the factors influencing it, including immunosuppressive regimen.
Methods |
A total of 96 LTRs (76 male) with a personal post-transplant history of squamous cell carcinoma, basal cell carcinoma or Bowen's disease were included, with a median follow-up of 12.4 years (range, 1.5-27.8) after liver transplantation.
Results |
The median follow-up after first NMSC was 6.4 years (range, 0.17-22.1). In all, 52 patients (53.1%) developed 141 subsequent NMSCs with a basal cell carcinoma–to–squamous cell carcinoma ratio of 1.8:1. The actuarial risk for development of a second NMSC was 13.7% at 1 year, 28.4% at 2 years, 49.4% at 5 years, 65.7% at 10 years, and 88.4% at 15 years. Multivariate analysis found that skin phototype I or II (vs III or IV) was a significant risk factor for development of a second NMSC (hazard ratio, 2.556; 95% confidence interval, 1.45-4.48; P = .001), whereas withdrawal of calcineurin inhibitors was significantly protective (hazard ratio, 0.358; 95% confidence interval, 0.142-0.902; P = .029).
Limitations |
Retrospective analysis.
Conclusions |
Subsequent NMSCs are very frequent in LTRs, and conversion from a calcineurin inhibitor–based immunosuppressive regimen to a mammalian target of rapamycin inhibitor/antimetabolite-based immunosuppressive regimen can reduce subsequent NMSCs.
Le texte complet de cet article est disponible en PDF.Key words : immunosuppression, incidence, liver transplantation, phenotype, predictive factors, skin cancer
Abbreviations used : BCC, CNI, KTR, LTR, mTORi, SCC, SD, SOTR
Plan
| Funding sources: None. |
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| Conflicts of interest: None disclosed. |
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| Drs Dumortier and Ducroux had the idea of the project and participated in analysis and interpretation of the data. Drs Boillot, Ursic-Bedoya, Pageaux, Guillaud, Ducroux, Dumortier, and Euvrard were involved in patient care and inclusion. Drs Funk-Debleds, Vallin, and Ducroux collected the data. Drs Funk-Debleds, Ducroux, and Dumortier participated in writing of the manuscript. Drs Ducroux, Boillot, Dumortier, Pageaux, and Euvrard participated in critical revision of the manuscript. Drs Guillaud and Decullier performed statistical analysis. |
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| Reprints not available from the authors. |
Vol 79 - N° 1
P. 84-91 - juillet 2018 Retour au numéro
Article précédent
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