Immunosuppressive level and other risk factors for basal cell carcinoma and squamous cell carcinoma in heart transplant recipients.
OBJECTIVE
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.


METHODS
Prospective nonconcurrent study.


METHODS
A dermatology clinic at a university hospital.


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


METHODS
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.
Fortina
Anna Belloni
AB
Unit of Dermatology and the Institute of Pathological Anatomy, University of Padua, Padua, Italy.
Piaserico
Stefano
S
Caforio
Alida L P
AL
Abeni
Damiano
D
Alaibac
Mauro
M
Angelini
Annalisa
A
Iliceto
Sabino
S
Peserico
Andrea
A
D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D001707:Biopsy, Needle; D002280:Basal Cell Carcinoma / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology; D018709:Statistics, Nonparametric; D014181:Transplantation Immunology / Q000502:physiology
D007166:Immunosuppressive Agents