Risk of cancer in heart transplant recipients. Associations between heart transplantation and skin cancer

Riziko zhoubných novotvarů u příjemců transplantátu srdce. Asociace mezi transplantací srdce a výskytem kožních nádorů. Úvod: Pacienti po transplantaci orgánů mají signifikantně vyšší riziko vzniku nádorových komplikací. Cíl: Analýza incidence, histologického spektra a klinického dopadu různých novotvarů u pacientů po transplantaci srdce jako podklad k programu sekundární prevence. Metodika: Retrospektivní kohortová studie byla provedena na 646 pacientech po transplantaci srdce, kteří absolvovali transplantaci v Institutu klinické a experimentální medicíny (IKEM) v období 1993-2011. Vztah mezi expozicí a výskytem zhoubných novotvarů byl popsán pomocí standardizovaných indexů morbidity (SMR) vypočtených pomocí nepřímé standardizace za současné kontroly věku, pohlaví a kalendářního období. Výsledky: Celkem bylo detekováno 194 incidentních případů nádorového onemocnění u 126 pacientů (19,5 %). Nejčastější byly kožní novotvary (62 %), následovány jinými nádory solidních orgánů (35 %) a skupinou post-transplantačních lymfoproliferativních onemocnění (6 %). Závěr:Kožní nádory představují významnou komplikaci u pacientů po transplantaci srdce a zdůrazňují potřebu pravidelných kontrol dermatologem jako součást sekundární prevence.The risk of cancer in heart transplant recipients. Association between heart transplantation and the incidence of skin cancer. Background:Organ transplant recipients are at significantly higher risk for developing a wide range of malignant tumours. Aim: Analysis of the incidence, histological spectrum and clinical impact of various types of cancer in heart transplant recipients. Methods: A retrospective cohort study was performed on 646 heart transplant recipients who underwent heart transplantation between 1993-2011 in The Institute for Clinical and Experimental Medicine in Prague. Relative risks of cancer were estimated as standardized morbidity ratios. Results: In total, 194 incident cases of malignancy occurred in 126 patients (19,5 %). Skin cancer, solid organ tumours and lymphoma represented 62 %, 35 % and 6 % of the malignancies, respectively. Conclusion: These findings confirm the fact that cancer is an important complication for long-term survival in heart transplant recipients whereas post-transplant malignancies have variable clinical impact. Even though nonmelanoma skin cancer has predominantly benign course, we underscore the importance of regular skin cancer screening in the post-transplant period.Ústav epidemiologieDepartment of Epidemiology2. lékařská fakultaSecond Faculty of Medicin

Risk of cancer in heart transplant recipients. Associations between heart transplantation and skin cancer

The risk of cancer in heart transplant recipients. Association between heart transplantation and the incidence of skin cancer. Background:Organ transplant recipients are at significantly higher risk for developing a wide range of malignant tumours. Aim: Analysis of the incidence, histological spectrum and clinical impact of various types of cancer in heart transplant recipients. Methods: A retrospective cohort study was performed on 646 heart transplant recipients who underwent heart transplantation between 1993-2011 in The Institute for Clinical and Experimental Medicine in Prague. Relative risks of cancer were estimated as standardized morbidity ratios. Results: In total, 194 incident cases of malignancy occurred in 126 patients (19,5 %). Skin cancer, solid organ tumours and lymphoma represented 62 %, 35 % and 6 % of the malignancies, respectively. Conclusion: These findings confirm the fact that cancer is an important complication for long-term survival in heart transplant recipients whereas post-transplant malignancies have variable clinical impact. Even though nonmelanoma skin cancer has predominantly benign course, we underscore the importance of regular skin cancer screening in the post-transplant period

TOPICAL CORTICOSTEROIDS BUT NOT CALCINEURIN INHIBITORS INDUCED ATROPHY AFTER FOUR WEEKS

Reflectance confocal microscopy (RCM) is a non-invasive, in vivo technique for real-time imaging of the epidermis and superficial dermis at the cellular resolution. We performed a pilot study focusing on the evaluation of the effect of topical corticosteroids and calcineurin inhibitors on the epidermis of patients with atopic dermatitis (AD). The effect was assessed by RCM. A total of 45 patients with AD took part in the study. Patients were selected according to the standardized protocol and divided into two groups. Twenty-three patients used methylprednisolone aceponat topically on the skin with lesions of AD once a day for three months (group A). Twenty-one patients applied topical tacrolimus on the skin with lesions of AD twice a day for three months (B). RCM imaging was performed on the day of intiating the study (T0), then after one (T1), two (T2) and three months (T3). In group A, there was a visible decrease of the stratum corneum and the epidermis thickness which was statistically significant. In comparison, in group B, such changes were not noted and the differences between the groups in time course were statistically significant. In group A, an increase in the percentage of blurred keratinocytes in the stratum spinosum was also recorded, especially between the first (T0) and the second visit (T1). RCM is a useful method for evaluating the changes in epidermis due to the different topical treatment in patients with AD

TOPICAL CORTICOSTEROIDS BUT NOT CALCINEURIN INHIBITORS INDUCED ATROPHY AFTER FOUR WEEKS

Reflectance confocal microscopy (RCM) is a non-invasive, in vivo technique for real-time imaging of the epidermis and superficial dermis at the cellular resolution. We performed a pilot study focusing on the evaluation of the effect of topical corticosteroids and calcineurin inhibitors on the epidermis of patients with atopic dermatitis (AD). The effect was assessed by RCM. A total of 45 patients with AD took part in the study. Patients were selected according to the standardized protocol and divided into two groups. Twenty-three patients used methylprednisolone aceponat topically on the skin with lesions of AD once a day for three months (group A). Twenty-one patients applied topical tacrolimus on the skin with lesions of AD twice a day for three months (B). RCM imaging was performed on the day of intiating the study (T0), then after one (T1), two (T2) and three months (T3). In group A, there was a visible decrease of the stratum corneum and the epidermis thickness which was statistically significant. In comparison, in group B, such changes were not noted and the differences between the groups in time course were statistically significant. In group A, an increase in the percentage of blurred keratinocytes in the stratum spinosum was also recorded, especially between the first (T0) and the second visit (T1). RCM is a useful method for evaluating the changes in epidermis due to the different topical treatment in patients with AD