Skin and mucosa in patients with solid organ transplant: risks and precautions

Öz

In solid organ transplant patients; many skin diseases are more common and more resistant to treatment, because of the multiple medications and immunosuppressive therapies. In order to increase survival, it is important to evaluate and follow these patients with a multidisciplinary team including the dermatologist. In this review, the following are reviewed along with the current literature; skin and mucosa findings due to immunosuppressive therapies used in solid organ transplant patients, inflammatory, infectious and neoplastic skin diseases which are increased compared to the normal population, and the important points in diagnosis and treatment of these diseases.

Anahtar Kelimeler

• immunosuppression
• Organ transplantation
• skin neoplasm
• drug reaction
• opportunistic infection
• infection prevention

Solid organ transplantasyonlu hastalarda deri ve mukoza: Riskler ve önlemler

Öz

Solid organ nakli hastalarının kullandığı çoklu ilaçlar ve immünsupresif tedaviler nedeniyle birçok deri hastalığı bu hasta grubunda daha sık görülmekte ve tedaviye daha dirençli seyretmektedir. Hastaların, sağ kalımlarını arttırmak amacı ile içerisinde dermatoloji uzmanının da bulunduğu bir ekip tarafından multidisipliner olarak değerlendirilmesi ve takip edilmesi önemlidir. Bu derlemede solid organ nakli hastalarında kullanılan immünsupresif tedavilere bağlı görülen deri ve mukoza bulguları, topluma göre sıklığında artış gözlenen enflamatuar, enfeksiyöz ve neoplastik deri hastalıkları ile bu hastalıkların tanı ve tedavisinde dikkat edilmesi gereken noktalar güncel literatür eşliğinde gözden geçirilmiştir.

Anahtar Kelimeler

• organ nakli
• immünsupresyon
• deri kanserleri
• ilaç reaksiyonları
• fırsatçı enfeksiyonlar
• enfeksiyon önlemleri

Kaynakça

1. Alam M, Brown RN, Silber DH, et al. Increased incidence and mortality associated with skin cancers after cardiac transplant. Am J Transplant 2011;11:1488-97.
2. Metchnikoff C, Mully T, Singer J, et al. The 7th edition AJCC staging system for cutaneous squamous cell carcinoma accurately predicts risk of recurrence for heart and lung transplant recipients. J Am Acad Dermatol 2012;67:829-35.
3. Otley CC, Hirose R, Salasche SJ. Skin cancer as a contraindication to organ transplantation. Am J Transplant 2005;5:2079-84.
4. Hofbauer GFL, Freiberger SN, Iotzova-Weiss G, Shafaeddin B, Dziunycz PJ. Organ transplantation and skin-principles and concepts. Curr Probl Dermatol 2012;43:1-8.
5. Ali FR, Samarasinghe V, Russell SA, Lear JT. Increasing capacity for skin surveillance in a transplant review clinic. Transplantation 2014;97:48-50.
6. 6. Ulrich C, Arnold R, Frei U, et al. Skin changes following organ transplantation: an interdisciplinary challenge. Dtsch Arztebl Int 2014;111:188-94.
7. Lally A, Casabonne D, Newton R, Wojnarowska F. Seborrheic dermatitis among Oxford renal transplant recipients. J Eur Acad Dermatol Venereol 2010;24:561-4.
8. Mahe E, Morelon E, Lechaton S, et al. Acne in recipients of renal transplantation treated with sirolimus: clinical, microbiologic, histologic, therapeutic, and pathogenic aspects. J Am Acad Dermatol 2006;55:139-42.

9. Kralund H, Broesby-Olsen S, Bistrup C, et al. Substantial effect of topical cidofovir 1% on recalcitrant warts in a renal-transplanted adolescent: a case report. Transplantation 2011;91:e52-4.
10. Vinzon SE, Braspenning-Wesch I, Muller M, et al. Protective vaccination against papillomavirusinduced skin tumors under immunocompetent and immunosuppressive conditions: a preclinical study using a natural outbred animal model. PLoS Pathog 2014;10:e1003924.
11. Shiley K, Blumberg E. Herpes viruses in transplant recipients: HSV, VZV, human herpes viruses, and EBV. Hematol Oncol Clin North Am 2011;25;171-91.
12. Stephan C, Kurban M, Khalil S, Bitar F, El-Rassi I, Assy J. Viral-associated trichodysplasia spinulosa in a paediatric cardiac transplant recipient. Clinical and Clin Exp Dermatol 2020;45:244-6.
13. Ozoguz P, Karaca S. Post-transplantation oncological and dermatological problems. Turkiye Klinikleri J Gen Surg-Special Topics 2013;6:142-9.
14. Hogewoning AA, Goettsch W, van Loveren H, de Fijter JW, Vermeer BJ, Bouwes Bavinck JN. Skin infections in renal transplant recipients. Clin Transplant 2001;15:32-8.
15. Ponticelli C, Bencini PL. Nonneoplastic mucocutaneous lesions in organ transplant recipients. Transpl Int 2011;24:1041-50.
16. Cakmak SK, Gonul M, Gul U, Unal T, Daglar E. Norwegian scabies in a renal transplant patient. Australas J Dermatol 2008;49:248-9.
17. Webb NJA, Coulthard MG, Trompeter RS, et al. Correlation between finger-prick and venous ciclosporin levels: Association with gingival overgrowth and hypertrichosis.Pediatr Nephrol 2007;22:2111-8.
18. Tricot L, Lebbe C, Pillebout E, et al. Tacrolimusinduced alopecia in female kidney-pancreas transplant recipients. Transplantation 2005;80:1546-9.
19. Campistol JM, de Fijter JW, Flechner SM, Langone A, Morelon E, Stockfleth E. MTOR inhibitorassociated dermatologic and mucosal problems. Clin Transplant 2010;24:149-56.
20. Euvrard S, Kanitakis J, Claudy A. Skin cancers after organ transplantation. N Engl J Med 2003;348:1681-91.
21. Kempf W, Mertz KD, Kanitakis J, Hofbauer GFL. Critical skin cancer in organ transplant recipients-a dermatopathological view. Curr Probl Dermatol 2012;43:18-35.
22. Jensen P, Hansen S, Moller B, et al. Skin cancer in kidney and heart transplant recipients and different long-term immunosuppressive therapy regimens. J Am Acad Dermatol 1999;40:177-86.
23. Lindelof B, Sigurgeirsson B, Gabel H, Stern RS. Incidence of skin cancer in 5356 patients following organ transplantation. Br J Dermatol 2000;143:513-9.
24. Surber C, Pittelkow M, Lautenschlager S. Photoprotection in transplant recipients. Curr Probl Dermatol 2012;43:171-96.
25. Ulrich C, Kanitakis J, Stockfleth E, Euvrard S. Skin cancer in organ transplant recipients - Where do we stand today? Am J Transplant 2008;8:2192-8.
26. Bouwes Bavinck JN, Neale RE, Abeni D, et al. Multicenter study of the association between betapapillomavirus infection and cutaneous squamous cell carcinoma. Cancer Res 2010;70:9777-86.
27. Mertz KD, Proske D, Kettelhack N, et al. Basal cell carcinoma in a series of renal transplant recipients: Epidemiology and clinicopathologic features. Int J Dermatol 2010;49:385-9.
28. Buell J, Trofe J, Hanaway MJ, et al. Immunosuppression and Merkel cell cancer. Transplant Proc 2002;34:1780-1.
29. Koljonen V, Kukko H, Tukiainen E, et al. Incidence of Merkel cell carcinoma in renal transplant recipients. Nephrol Dial Transplant 2009;24:3231-5.
30. Heath M, Jaimes N, Lemos B, et al. Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features. J Am Acad Dermatol 2008;58:375-81.
31. Feng H, Shuda M, Chang Y, Moore PS. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science 2008;319:1096-100.
32. Lemos B, Storer B, Iyer J, et al. Pathologic nodal evaluation improves prognostic accuracy in Merkel cell carcinoma: analysis of 5823 cases as the basis of the first consensus staging system. J Am Acad Dermatol 2010;63:751-61.
33. Harwood C, McGregor J, Swale VJ, et al. High frequency and diversity of cutaneous appendageal tumors in organ transplant recipients. J Am Acad Dermatol 2003;48:401-8.
34. Kasiske BL, Snyder JJ, Gilbertson DT, Wang C. Cancer after kidney transplantation in the United States. Am J Transplant 2004;4:905-13.
35. le Mire L, Hollowood K, Gray D, Bordea C, Wojnarowska F. Melanomas in renal transplant recipients. Br J Dermatol 2006;154:472-7.
36. I Penn. Malignant melanoma in organ allograft recipients. Transplantation 1996;61:274-8.
37. Brewer J, Christenson L, Weaver AL, et al. Malignant melanoma in solid transplant recipients: collection of database cases and comparison with surveillance, epidemiology, and end results data for outcome analysis. Arch Dermatol 2011;147:790-6.
38. Robin YM, Guillou L, Michels JJ, Coindre JM. Human herpesvirus 8 immunostaining: a sensitive and specific method for diagnosing Kaposi sarcoma in paraffin-embedded sections. Am J Clin Pathol 2004;121:330-4.
39. Pedagogos E, Nicholls K, Dowlıng J, Becker G. Kaposi’s sarcoma post renal transplantation. Aust N Z J Med 1994;24:722-3.
40. Hofbauer GFL, Bavinck JNB, Euvrard S. Organtransplantation and skin cancer: basic problems and new perspectives. Exp Dermatol 2010;19:473-82.
41. Beynet D, Wee S, Horwitz S, et al. Clinical and pathological features of posttransplantation lymphoproliferative disorders presenting with skin involvement in 4 patients. Arch Dermatol 2004;140:1140-6.
42. Yurtsever H, Kempf W, Laeng RH. Posttransplant CD30+ anaplastic large cell lymphoma with skin and lymph node involvement. Dermatology 2003;207:107-10.
43. Schreve B, Anliker M, Arnold A, et al. Preand posttransplant management of solid organ transplant recipients: risk-adjusted follow-up. Curr Probl Dermatol 2012;43:57-70.
44. Hofbauer GFL, Attard NR, Harwood CA, et al. Reversal of UVA skin photosensitivity and DNA damage in kidney transplant recipients by replacing azathioprine. Am J Transplant 2012;12:218-25.
45. Campistol JM, Gutierrez-Dalmau A, Torregrosa JV. Conversion to sirolimus: a successful treatment for posttransplantation Kaposi’s sarcoma. Transplantation 2004;77:760-2.
46. Vincenti F, Schena FP, Paraskevas S, Hauser IA, Walker RG, Grinyo J. A randomized, multicenter study of steroid avoidance, early steroid withdrawal or standard steroid therapy in kidney transplant recipients. Am J Transplant 2008;8:307-16.
47. Bavinck JNB, Tieben LM, van der Woude FJ, et al. Prevention of skin cancer and reduction of keratotic skin lesions during acitretin therapy in renal transplant recipients: A double-blind, placebocontrolled study. J Clin Oncol 1995;13:1933-8.
48. Harwood CA. Low-dose retinoids in the prevention of cutaneous squamous cell carcinomas in organ transplant recipients a 16-year retrospective study. Arch Dermatol 2005;141:456-64.
49. George R, Weightman W, Russ GR, Bannister KM, Mathew TH. Acitretin for chemoprevention of non-melanoma skin cancers in renal transplant recipients. Australas J Dermatol 2002;43:269-73.
50. Zecher D, Steiger J. Future trends in organ transplant recipients-important issues for dermatologists. Curr Probl Dermatol 2012;43:71-80.