Subsequent nonmelanoma skin cancers and impact of immunosuppression in liver transplant recipients - Archive ouverte HAL
Article Dans Une Revue Journal of The American Academy of Dermatology Année : 2018

Subsequent nonmelanoma skin cancers and impact of immunosuppression in liver transplant recipients

Résumé

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.
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hal-02355791 , version 1 (08-11-2019)

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Pamela Funk-Debleds, Emilie Ducroux, Olivier Guillaud, José Ursic-Bedoya, Evelyne Decullier, et al.. Subsequent nonmelanoma skin cancers and impact of immunosuppression in liver transplant recipients. Journal of The American Academy of Dermatology, 2018, 79 (1), pp.84--91. ⟨10.1016/j.jaad.2017.12.063⟩. ⟨hal-02355791⟩
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