This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (10)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Cardiovascular Interventions, Other  • Cardiovascular System  • Surgery  • Cardiac Transplantation  • Dermatologic Procedures  • Dermatologic Laser Surgery  • Immunology, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

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

Arch Dermatol. 2004;140:1079-1085.

Objectives  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.

Design  Prospective nonconcurrent study.

Setting  A dermatology clinic at a university hospital.

Patients  A total of 230 HT recipients 18 years or older at the time of transplantation with at least 3 years of follow-up.

Main Outcome Measures  The risk of SCC and BCC in HT recipients and the relationship between development of SCC and BCC and cumulative doses of different immunosuppressive agents, controlling for other potential risk factors (age, sex, sunlight exposure, skin type, and presence of warts).

Results  The cumulative immunosuppressive drug dose 3 years after transplantation (calculated by a weighted linear combination of azathioprine, cyclosporine, and corticosteroid cumulative doses [WLC]) was independently associated with an increased risk of developing SCC but not BCC. On multivariate analysis, patients receiving a WLC higher than the 75th percentile 3 years after HT had a 4 times higher risk of SCC than recipients of a WLC lower than the 50th percentile 3 years after HT (95% confidence interval, 1.4-11.4; P = .008). Other significant risk factors for SCC development were older age at transplantation and a greater occupational sunlight exposure. The risk of developing BCC was only associated with older age at transplantation and skin type II.

Conclusions  The risk of SCC but not of BCC in HT recipients was related to the level of global immunosuppression rather than to 1 specific drug. The level of immunosuppression should be kept as low as possible consistent with survival and function of the transplanted organ.

From the Units of Dermatology (Drs Belloni Fortina, Piaserico, Alaibac, and Peserico) and Cardiology (Drs Caforio and Iliceto) and the Institute of Pathological Anatomy (Dr Angelini), University of Padua, Padua, Italy; and Istituto Dermopatico dell'Immacolata–Istituto di Ricovero a Cura a Carattere Scientifico, Rome, Italy (Dr Abeni). The authors have no relevant financial interest in this article.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Association Between Statin Use and Risk for Keratinocyte Carcinoma in the Veterans Affairs Topical Tretinoin Chemoprevention Trial
Dore et al.
ANN INTERN MED 2009;150:9-18.
ABSTRACT | FULL TEXT  

Post-transplant lymphoproliferative disorder--the potential of proliferation signal inhibitors
Pascual
Nephrol Dial Transplant 2007;22:i27-i35.
ABSTRACT | FULL TEXT