Assuntos
Alcaptonúria/patologia , Alcaptonúria/terapia , Dermatoses Faciais/patologia , Dermatoses Faciais/terapia , Ocronose/patologia , Ocronose/terapia , Administração Tópica , Biópsia por Agulha , Terapia Combinada , Fármacos Dermatológicos/uso terapêutico , Feminino , Humanos , Imuno-Histoquímica , Terapia a Laser/métodos , Pessoa de Meia-Idade , Doenças Raras , Resultado do TratamentoAssuntos
Argas/imunologia , Celulite (Flegmão)/etiologia , Eosinofilia/etiologia , Picadas de Carrapatos/complicações , Adulto , Animais , Biópsia por Agulha , Celulite (Flegmão)/imunologia , Celulite (Flegmão)/patologia , Eosinofilia/imunologia , Eosinofilia/patologia , Feminino , Humanos , Imuno-Histoquímica , Doenças Raras , Picadas de Carrapatos/imunologiaRESUMO
BACKGROUND: The course of skin cancer after retransplantation in organ-transplant recipients who have already developed posttransplant skin cancer has not been assessed. METHODS: This retrospective multicentric study included 53 patients with a history of cutaneous squamous cell carcinoma (SCC) after a first kidney transplantation who received a second kidney transplantation. The primary endpoint was the occurrence of aggressive cutaneous SCC after the second transplantation. Secondary endpoints included the course of skin cancers over 3 periods (first transplantation, return to dialysis, second transplantation), the time to occurrence, and risk factors for aggressive SCC after retransplantation. RESULTS: The first SCC developed in 47 patients with a functional graft and in 6 after return to dialysis. After the first transplantation, 17 (33.3%) patients developed SCC in dialysis and 39 (73.6%) after the second transplantation, respectively. Twenty aggressive SCC developed over the study period. They occurred in 14 (26.4%) patients after retransplantation vs 5 (9.4%) after the first transplantation with a median delay of 50 months and were responsible for 5 deaths. Fair skin type, multiple tumors before retransplantation, treatment with azathioprine, T cell-depleting antibodies, and delayed revision of immunosuppression were associated with an increased risk of aggressive cutaneous SCC after retransplantation. CONCLUSIONS: Candidates to retransplantation with a history of posttransplant SCC have a high risk of aggressive SCC. Our data suggest that the risk could be reduced by a tailored immunosuppression. A wait period may be required depending on the clinicopathological characteristics of the previous SCC and discussed on an individual patient basis.