Background &
objectives: Kidney transplantation is the best option for
patients with
end-stage renal disease (
ESRD ) failure. Prolonged use of immunosuppressive
drugs often causes
opportunistic infections and
malignancies of
skin and mucosae, but due to lack of a careful dermatological
screening in several
transplantation centers the
diagnosis and the
treatment of dermatological lesions in
kidney transplant patients are underestimated. In addition after the introduction of
interleukin (IL)-2 -receptor antagonists (
basiliximab /
daclizumab ),
mTOR inhibitors and
mycophenolate mofetil (MMF)/
mycophenolic acid (MPA) in new immunosuppressive
protocols only a few studies have analyzed the
skin and mucosal lesions in
kidney transplant patients . This study was undertaken to evaluate the cutaneous and mucosal
diseases after
kidney transplantation , and to investigate the
association between these and different immunosuppressive
protocols and/or demographic features.
Methods: A retrospective
analysis was done using
medical records of
kidney transplantation between 2000 and 2009 at the
Transplant Unit of Fondazione IRCCS Policlinico San Matteo, Pavia,
Italy . The study included 183
patients (M 57.3%, F 42.7%)
aged 51.5±11.8 yr) with
transplant age 52.3±34.9 months. Induction
therapy was
basiliximab and
steroids based;
maintenance therapy included combination-regimes from
cyclosporine ,
tacrolimus ,
steroids ,
mycophenolate mofetil (MM),
mycophenolic acid (MPA),
rapamycin ,
everolimus .
Anti-rejection therapy was
steroid and/or thymoglobulines based.
Diagnosis of cutaneous
disease was made through examination of
skin ,
mucous membranes ,
nails and
hair evaluation.
Skin biopsies , specific
cultures and
serological tests were done when required.
Results: Skin and mucosal
diseases were reported in 173 (95.7%) of
patients ; 88 (50.81%) showed viral lesions; 92 (53.01%)
immunosuppression -related lesions; 28 (16.39%) benign tumours; 26 (15.3%) precancers /neoplastic lesions; 24 (14.21%) mycosis; 16 (9.29%) cutaneous xerosis, 15 (8.74%)
dermatitis , while absence of cutaneous
disease was evident only in 8 (4.37%) cases. An
association between
drug side effects and anti-rejection
treatment (P≤0.01) and/or
calcineurin -inhibitors (CNI) exposure (P≤0.01) was found. Longer exposure to immunosuppressive
drugs (>60 months) was associated with pre-
malignancy and
malignancy lesions. Interpretation &
conclusions: Cutaneous
diseases are frequent in
kidney transplanted
patients . Continuous
skin monitoring is necessary to make an
early diagnosis and to start appropriate
treatment .