Mucocutaneous complications in pediatric patients with liver transplantation

Abstract

Background Liver transplant recipients can develop mucocutaneous lesions and the severity of these lesions can vary from benign to life-threatening conditions. The aim of this study was to investigate the frequency and clinical features of mucocutaneous complications after liver transplantation (LT) in pediatric patients. Methods Retrospectively, children who underwent LT and were detected with skin and mucosa lesions while being followed up in our Pediatric Gastroenterology outpatient clinic between June 2005 and July 2020 were evaluated. Age, gender, primary diagnosis, graft type, immunosuppression history and post-transplantation mucocutaneous complications were recorded from the patients’ file. Results Mucocutaneous lesions were observed in 16 (9 girls, 7 boys) of 37 patients after LT. Mean transplantation age ± SD was 1.96 ± 2.03 years and a mean follow-up period was 7.31 ± 2.69 years. The lesions due to viral infections were the most common dermatologic findings (n=7, 20.5%), followed by soft tissue infection (n=6), xerosis (n=5), urticaria (n=3), eczema (n=2), fissured tongue (n=3), acne vulgaris (n=3), tinea (n=2), alopecia areata (n=1), oral aphthae (n=1) and leukocytoclastic vasculitis (n=1). No premalignant or malignant lesion was detected in any patient. Conclusion Studies about mucocutaneous complications are limited in children after LT and these lesions are often caused by infections associated with the side effects of immunosuppressive treatment. Accordingly, a carefully dermatological examination should be performed during the follow-up of patients undergoing LT.

Keywords

• liver transplantation
• immunosuppressive treatment
• mucocutaneous complications

Karaciğer nakilli çocuk hastalarda mukokutanöz komplikasyonlar

Abstract

Amaç Karaciğer nakil hastalarında mukokutanöz lezyonlar yüzeysel cilt lezyonlarından yaşamı tehdit eden ciddi durumlara kadar değişkenlik göstermektedir. Bu çalışmada merkezimizde takip edilen karaciğer nakilli çocuk hastalarda gözlenen mukokutanöz komplikasyonların sıklığı ve klinik özellikleri değerlendirilmiştir. Yöntem Haziran 2005 - Temmuz 2020 tarihleri arasında çocuk gastroenteroloji polikliniğinde takip edilen karaciğer nakilli çocuk hastaların dosyaları retrospektif olarak incelendi. Yaş, cinsiyet, birincil tanı, greft tipi, immünosupresyon tedavisi ve transplantasyon sonrası mukokutanöz komplikasyonlar hasta dosyalarından kaydedildi. Bulgular Karaciğer nakli sonrası mukokutanöz lezyonlar 37 hastanın 16’sında (9 kız,7 erkek) gözlendi. Ortalama nakil yaşı ± SD 1.96 ± 2.03 yıl ve ortalama takip süresi 7.31 ± 2.69 yıldı. Dermatolojik bulgulardan en sık viral enfeksiyonlara bağlı cilt lezyonları (n=7, %20.5) görülürken, bunu yumuşak doku enfeksiyonu (n=6), kserozis (n=5), ürtiker (n=3), egzama (n=2), dilde yarıklanma (n=3), akne vulgaris (n=3), tinea (n=2), alopesi areata (n=1), oral aft (n=1) ve lökositoklastik vaskülit (n=1) takip etti. Premalign ve malign lezyon izlenmedi. Sonuç Karaciğer transplantasyonu sonrası çocuklarda mukokutanöz komplikasyonlarla ilgili çalışmalar sınırlıdır ve bu lezyonlar genellikle immünosupresif tedavinin yan etkileriyle ilişkili enfeksiyonlardan kaynaklanır. Bu nedenle nakil yapılan hastaların takibinde dikkatli bir dermatolojik muayene yapılmalıdır.

Keywords

• karaciğer nakli
• immünsupresif tedavi
• mukokutanöz komplikasyonlar

References

1. Imko-Walczuk B, Roskosz-Stozkowska M, Szymanska K, Kadylak D, Debska-Slizien A. Skin cancer in children after organ transplantation. Postepy Dermatol Alergol 2019;36:649-54.
2. Yadav DK, Bai XL, Liang T. Dermatological disorders following liver transplantation: An update. Can J Gastroenterol Hepatol 2019;2019:9780952.
3. Ertam I, Alper S, Unal I. et al. Karaciğer transplant hastalarında deri bulgularının transplantasyon süresi ile ilişkisi. Turk J Dermatol 2013;7:72-5.
4. Ilyas M, Maganty N, Ginsberg Z, Sharma A. Skin infections due to bacteria in solid organ transplant recipients: a review. Dermatology 2017;233:358-65.
5. Naldi L, Venturuzzo A, Invernizzi P. Dermatological complications after solid organ transplantation. Clin Rev Allergy Immunol 2018;54:185-212.
6. Hernandez M del P, Martin P, Simkins J. Infectious complications after liver transplantation. Gastroenterol Hepatol (N Y) 2015;11:741-53.
7. Kim JE, Oh SH, Kim KM, et al. Infections after living donor liver transplantation in children. J Korean Med Sci 2010;25:527-31.
8. Schmied E, Dufour JF, Euvrard S. Nontumoral dermatologic problems after liver transplantation. Liver Transpl 2004;10:331-9.

9. Ilyas M, Sharma A. Cutaneous fungal infections in solid organ transplant recipients. Transplant Rev (Orlando) 2017;31:158-65.
10. Dicle O, Parmaksizoglu B, Gurkan A, Tuncer M, Demirbas A, Yilmaz E. Skin infections in 401 renal transplant recipients in southern Turkey. Exp Clin Transplant 2009;7:133-6.
11. Yang JW, Liao SS, Zhu LQ, et al. Population pharmacokinetic analysis of tacrolimus early after Chinese pediatric liver transplantation. Int J Clin Pharmacol Ther 2015;53:75-83.
12. Dumortier J, Couchonnal E, Lacaille F, et al. mTOR inhibitors in pediatric liver transplant recipients. Clin Res Hepatol Gastroenterol 2019;43:403-9.
13. Almaas R, Haflidadottir S, Kaldestad RH, Matthews IL. Asthma, eczema, and food allergy in children following liver transplantation. J Pediatr 2019;204:263-9.
14. Topal E, Catal F, Selimoglu MA, et al. Acquired atopic disease after liver transplantation in children; similarities to and differences from adults: a preliminary study. Eur J Gastroenterol Hepatol 2014;26:1055-9.
15. Ilyas M, Sharma A. Leukocytoclastic vasculitis in transplant recipients: A case series of 7 patients. JAAD Case Rep 2017;3:291-3.
16. Hassan G, Khalaf H, Mourad W. Dermatologic complications after liver transplantation: a single-center experience. Transplant Proc 2007;39:1190-4.