Dermatological disease in heart and lung transplant recipients

Abstract

Introduction: Skin disease is common in immunosuppressed solid organ transplant recipients (SOTRs) and skin cancer, in particular, is a major cause of morbidity and mortality in these patients. This study aims to determine the rates and risk factors for skin cancer in Australian heart and lung transplant recipients (HLTRs). It also aims to examine the spectrum of skin diseases encountered in HLTRs and their effect on quality of life (QOL). Methods: Ninety-four participants were recruited from the Dermatology Outpatient Clinic at St. Vincent’s Hospital Sydney between March and December 2016. Retrospective skin cancer diagnoses were obtained from medical records and participants were also examined prospectively for malignant and non-malignant skin disease. A questionnaire and the Dermatology Life Quality Index were administered to all participants. The probabilities of developing non-melanoma skin cancer (NMSC), squamous cell carcinoma (SCC), and basal cell carcinoma (BCC) were estimated using Kaplan-Meier analysis. The association of risk factors with skin cancer development were examined using the Cox proportional hazards model. The association of examined variables with DLQI score were assessed using univariate and multivariate logistic regression analysis. Results: Retrospectively, there were 801 post-transplant skin cancers in 61% of participants. At 5 and 10 years post-transplantation the probabilities were 41% and 67% for developing NMSC, 27% and 53% for developing BCC, and 33% and 62% for developing SCC, respectively. A prospective dermatological diagnosis was made in 87% of the participants over the study period. Actinic keratosis was the most common diagnosis, affecting 53% of participants, followed by skin cancer in 44% and warts in 15% of participants. Other non-malignant skin diseases were less common. Risk factors significantly associated with skin cancer included older age at transplantation, history of pre-transplant skin cancer, and history of ≥5 post-transplant skin cancers. Fitzpatrick skin type 3-6 was associated with a decreased risk of NMSC. Skin disease had a negative effect on the QOL of a minority of HLTRs. The use of tacrolimus was associated with better QOL scores on multivariate analysis. Conclusion: Australian HLTRs have high rates of skin cancer that exceed the rates reported for other SOTRs.