Immunosuppressive treatment after solid organ transplantation and risk of post-transplant cutaneous squamous cell carcinoma

Abstract

This study provides evidence that Aza treatment, but not cyclosporine treatment, is strongly associated with post-transplant CSCC risk. The results suggest that the risk of CSCC after organ transplantation is not only an effect of the immunosuppressive load per se.

The Epidemiology of Cancers in Human Immunodeficiency Virus Infection and After Organ Transplantation

“…43, 87 In a Swedish population-based nested case-control study of solid-organ transplant recipients, patients with high accumulated doses of azathioprine had an 8.8-fold risk of SCC compared to patients never treated with azathioprine. 88 In support of an association with the intensity of immunosuppression, risk of SCC is increased in heart compared to kidney transplant recipients, and in recipients taking cyclosporine and azathioprine compared to azathioprine alone. 89 The duration of immunosuppression is also important, with all studies showing an increase in SCC risk with increasing time since transplantation.…”

High-risk Cutaneous Squamous Cell Carcinoma

“…17,40 Immunosuppression is associated with higher rates of cSCC. 41,42 Solid organ transplant recipients, such as renal transplant patients, demonstrate a 100-fold increased risk for invasive cSCC compared with the general population. 41 Patients transplanted at an older age with a prior history of sun damage or with longer duration or greater intensity of immunosuppression may be at greater risk of developing cSCC.…”

Immunological Considerations for Inducing Skin Graft Tolerance

“…The spoken or unspoken hypothesis behind the use of generalized immunosuppression may be stated as follows: If the immune system in an otherwise healthy individual is capable of recognizing foreign tissue and mounting an attack against it, then significantly reducing all such recognition may allow for engrafted tissue to remain intact and functional. Many of these procedures required protracted or life-long treatments with unanticipated or negative sequelae (Ingvar et al, 2010, Berardinelli et al, 2009. The goal of these broad-based protocols was to protect the viability of the graft in order to protect the life of the host.…”