Immunosuppressive Level and Other Risk Factors for Basal Cell Carcinoma and Squamous Cell Carcinoma in Heart Transplant Recipients

Fortina, Anna Belloni; Piaserico, Stefano; Caforio, Alida L.P.; Abeni, Damiano; Alaibac, Mauro; Angelini, Annalisa; Iliceto, Sabino; Peserico, Andrea

doi:10.1001/archderm.140.9.1079

Cited by 110 publications

(77 citation statements)

References 35 publications

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“…In patients who have had solid organ transplantation, the incidence of SCC is higher as the duration and the level of immunosuppression increases, and it also increases in areas where there are sunny climates ( 131,132 ). Within a period of a decade aft er transplantation ~35% of heart transplant recipients will develop a skin with current users.…”

Section: Epidemiology In Ibd Patientsmentioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

379

406

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Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

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Section: Epidemiology In Ibd Patientsmentioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

379

406

View full text Add to dashboard Cite

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“…Risk for BCC in kidney transplant recipients is 10-16 times higher than in non-immunocompromised individuals [21,45]. Immunosuppressive treatment, age at the time of transplantation, male sex, skin type II, and environmental exposure to UV radiation are major risk factors in the development of non-melanoma skin cancer (NMSC) in organ transplant recipients [6,[16][17][18]. BCCs in transplant recipients develop at younger age, occur more frequently on extracranial locations, are more often of superficial type, have poorer inflammatory response and show slightly more frequent squamous differentiation compared with the nontransplanted population [21,25].…”

Section: Introductionmentioning

confidence: 99%

Differential expression of stromal MMP-1, MMP-9 and TIMP-1 in basal cell carcinomas of immunosuppressed patients and controls

et al. 2007

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Matrix metalloproteinases (MMPs) have an important role in the initiation, growth, and invasion of malignant tumors. Basal cell cancer (BCC) is the most common human malignancy. The risk of BCC is 10-16 times higher among organ transplant recipients compared with the nontransplanted population. The aim of this study was to compare the expression of several MMPs and their tissue inhibitors (TIMPs) in BCCs from kidney transplant recipients and controls. Expression of MMPs-1, -7, -8, -9, -10, -13, -26, and TIMPs-1 and -3 was evaluated by immunohistochemistry in 25 samples of BCC of kidney transplant recipients and 25 matched controls representing superficial and nodular subtypes. No significant differences were detected in MMP expression of BCC tumor cells between immunocompetent and immunodeficient patients. However, MMPs-1 and -9 and TIMP-1 were expressed more frequently in stromal macrophages in the BCCs of immunocompetent patients. When tumor subtypes were compared irrespective of the patient group, more MMP-1-positive fibroblasts and MMP-9-positive neutrophils were detected in the superficial subtype, while stromal MMP-10 expression was more abundant in nodular tumors. Our results suggest that abundant peritumoral expression of TIMP-1 in non-immunocompromised patients limits ECM degradation permissive for cancer cell migration.

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“…Bestehende Warzen und besonders die Diagnose von mehr als 10 Warzen waren signifikant mit der späteren Entwicklung von AK, invasiven PEC und BCC in unserem Patientenkollektiv assoziiert. Es muss dabei betont werden, dass in unseren Analysen "keratotische Läsionen" (hauptsächlich aktinische Keratosen, aber auch seborrhoische Warzen, plane Warzen, hyperkeratotische Papillome) von klassischen Warzen abgegrenzt wurden [11,12]. Entsprechend aktuellen histopathologischen Definition repräsentieren aktinische Keratosen bereits eine In-situ-Form des PEC (In-situ-PEC).…”

Section: Tab 3 Zusammenfassung Therapeutisches Managementunclassified

“…Entsprechend aktuellen histopathologischen Definition repräsentieren aktinische Keratosen bereits eine In-situ-Form des PEC (In-situ-PEC). Da AK bei Organtransplantierten zudem ein beschleunigtes Progressionsverhalten zeigt, erscheint ihre Funktion als frühzeitiger Indikator für ein erhöhtes Hauttumorrisiko unter Immunsuppression limitiert [12,33]. …”

Section: Tab 3 Zusammenfassung Therapeutisches Managementunclassified

“…Des Weiteren könnte sowohl die häufig beobachtete zeitliche Kongruenz als auch eine örtliche Vergesellschaftung von Warzen und unterschiedlichen Entwicklungsstadien des Plattenepithelkarzinoms bei Immunsupprimierten eine Relevanz bestimmter HPV-Typen in der Hauttumorgenese andeuten [10,11]. Allerdings konnte in einer italienischen Singlecenterstudie bei 230 Herztransplantierten kein Zusammenhang zwischen der Präsenz von Warzen und dem Auftreten von PEC oder Basalzellkarzinomen (BCC) beobachtet werden [12]. Die Prävalenz von Warzen und PEC stieg überproportional zu den Jahren nach einer Organtransplantation an.…”

Section: Introductionunclassified

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Human papillomavirus-associated warts in organ transplant recipients

et al. 2010

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Human papillomaviruses infect the squamous epithelia of the skin and cause warts, and are occasionally found in squamous cell carcinomas. Since cell-mediated immunity plays a crucial role in the control of HPV-infections, organ transplant recipients, unable to mount an adequate T-helper 1 cell-mediated immune surveillance, frequently develop widespread and resistant induced warts. Skin tumors, especially squamous cell carcinomas, are the most common post-transplantation neoplasm. Warts, actinic keratoses and invasive squamous cell carcinomas are known to develop at the same time in the areas. The role of HPV in the development of invasive squamous cell carcinoma under immunosuppression, remains to be elucidated in respect to common risk factors and increased numbers of warts potentially identifying patients at increased risk for carcinoma. We prospectively studied 1690 organ transplant recipients in the dermatology clinic at the Charité University Hospital in Berlin, to evaluate risk factors being involved in the development of HPV-induced warts and to assess a potential association of with the development of non-melanoma skin cancers in this population. The cumulative incidence of warts steadily increased throughout the post-transplant years. The presence of more than 10 verrucae was associated with the development of actinic keratoses, invasive squamous cell carcinoma and basal cell carcinoma. This study shows clear evidence that certain risk factors of skin carcinogenesis in organ transplant recipient such as increased age at transplantation, a high dose of immunosuppression related to a specific type of graft and use of azathioprine or cyclosporine are strongly associated with an increased incidence of warts. Furthermore, HPV-induced verrucae vulgares could be used as a potential predictor for the development of coincidental non melanoma skin cancer in organ transplant recipients and therefore could serve as an early identification marker of skin cancer high-risk patients. The challenging management of warts in organ transplantation patients is reviewed.

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Immunosuppressive Level and Other Risk Factors for Basal Cell Carcinoma and Squamous Cell Carcinoma in Heart Transplant Recipients

Abstract: To examine risk factors for the development of squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) in a cohort of heart transplant (HT) recipients and, in particular, to evaluate the role of the cumulative doses of different immunosuppressive drugs.

Cited by 110 publications

References 35 publications

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Differential expression of stromal MMP-1, MMP-9 and TIMP-1 in basal cell carcinomas of immunosuppressed patients and controls

Human papillomavirus-associated warts in organ transplant recipients

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